右美托咪定联合球后神经阻滞在小儿眼球摘除眼座置入术中的应用

Combination of dexmedetomidine with retrobulbar block in pediatric patients undergoing enucleation of eyeballs

目的 研究小儿眼球摘除眼座置入手术中采用右美托咪定（dexmedetomidine,Dex）联合球后神经阻滞对于患儿术中管理、术后疼痛及恢复质量的影响. 方法 选择拟行眼球摘除眼座置入术的患儿45例,年龄1~6岁,采用随机数字表法分为3组（每组15例）：Dex联合球后神经阻滞组（ND组）、球后神经阻滞组（N组）和Dex组（D组）.ND组诱导后10 min静脉泵注Dex 0.5 μg/kg,手术前行球后神经阻滞;N组仅在手术前行球后神经阻滞;D组仅在诱导后10 min静脉泵注0.5 μg/kg Dex.观察并记录患儿眼座置入前（T1）、置入时（T2）、置入后（T3）、拔出喉罩时（T4）以及出PACU时（T5）的HR和MAP,拔管时间以及出PACU时间,术后2、6、24 h的疼痛评分,术后镇痛药物使用情况,恶心呕吐,睡眠质量满意度评估及不良事件等. 结果 ND组及N组患儿在T2时心动过缓发生率（分别为8.3%和0）低于D组（41.7%）（P〈0.05）.术后2、6 h疼痛评分ND组分别为0（1）、0（1）,低于N组[分别为2（2）、2（1）]及D组[分别为3（1）、2（1）]（P〈0.05）,且术后24 h内肛塞对乙酰氨基酚的需求明显降低（P〈0.05）.ND组及N组患儿术后24 h内PONV发生严重程度评分为2分及3分患儿明显低于D组（P〈0.05）.患儿家属对术后24 h整体满意度ND组最高（P〈0.05）. 结论 Dex联合球后神经阻滞用于小儿全身麻醉眼球摘除术能有效减少术中牵拉反射,术后早期镇痛效果好,并有效减轻术后恶心呕吐的严重程度.

Objective To evaluate effects of retrobulbar block combined with dexmedetomidine （Dex） on intraoperative management,postoperative pain,and recovery quality in pediatric patients undergoing enucleation of eyeballs. Methods Forty five pediatric patients （1-6 years） scheduled for enucleation of eyeballs were enrolled and randomly assigned into 3 groups （n=15）, respectively received retrobulbar block combined with Dex（group ND）, retrobulbar block（group N）, and Dex（group D）. In group ND, 0.5 μg/kg Dex was infused within 10 min after induction of anesthesia, and retrobulbar nerve block was achieved by surgeon before enucleation of eyeballs. In group N, retrobulbar nerve block was achieved before enucleation of eyeballs. In group D, 0.5 μg/kg Dex was administrated after induction of anesthesia. The MAP and HR were recorded before （T1）, during （T2）, and after （T3） the placement of orbital implant, and immediately after the removal of laryngeal mask airway （T4） and leave from PACU （T5）. The pain scales, postoperative analgesics usage, nausea, and vomiting were assessed 2, 6 h and 24 h after operation. The perioperative adverse events were also recorded. Satisfaction regarding sleeping and pain condition was rated by parents 24 h after operation. Results The incidence of bradycardia during orbital implant placement was lower in group ND（8.3%）and group N（0）than in group D（41.7%, P〈0.05）. Pain scales in group ND[0（1）,0（1）]were lower than those in group N[2（2）, 2（1）] and group D [3（1）, 2（1）] 2 h and 6 h after operation（P〈0.05）, but not 24 h afte r operation. In group ND, patients used less anal acetaminophen compared with other two groups. The severity of nausea and vomiting （no less than 2）in group ND and group N was significantly lower than that in group D.Satisfactory scores were the highest in group ND. Conclusions Retrobulbar block combined with Dex decreased oculocardiac reflex during enucleation of eyeballs in pediatric patients,and provided more satisfactory analgesic effects with fewer incidences of nausea and vomiting.