右美托咪定复合罗哌卡因骶管阻滞用于小儿疝囊高位结扎术围术期镇痛效果评估

Effect Evaluation on Caudal Block with Dexmedetomidine Combined with Ropivacaine for Perioperative Analgesia in High Ligation of Hernia Sac of Children

目的探讨右美托咪定联合罗哌卡因骶管阻滞用于小儿疝囊高位结扎术围术期镇痛的效果。方法选取2013年5月至2015年10月择期行单纯疝囊高位结扎术患儿60例,随机分为高剂量组、常规剂量组和对照组,各20例。骶管阻滞药物,对照组采用0.25%罗哌卡因,常规剂量组采用0.25%罗哌卡因联合1μg/kg右美托咪定,高剂量组采用0.25%罗哌卡因联合2μg/kg右美托咪定。结果 3组患儿麻醉时间无显著性差异(P>0.05);高剂量组和常规剂量组患儿骶管阻滞起效时间明显短于对照组患儿,布洛芬使用率、躁动发生率均明显低于对照组患儿(P<0.05),持续镇痛时间、苏醒时间均明显长于对照组患儿(P<0.05);高剂量组持续镇痛时间、苏醒时间、布洛芬使用率均明显优于常规剂量组(P<0.05);高剂量组骶管阻滞起效时间、躁动发生率与常规剂量组比较,无显著性差异(P>0.05);对照组、常规剂量组、高剂量组不良反应发生率分别为20.00%,25.00%,30.00%,组间比较均无显著性差异(P>0.05)。结论高剂量右美托咪定联合罗哌卡因骶管阻滞起效时间更短,术后镇痛时间更长,术后躁动率与镇痛药的使用率更低,且安全性较高,值得推广。

Objective To investigate the effect of canal block with dexmedetomidine combined with ropivacaine for perioperative analgesia in children patients with hernia sac undergoing high ligation. Methods Totally 60 children patients with hernia sac undergoing high ligation from May 2013 to October 2015 in our hospital were selected and randomly divided into three groups： the high dose group,the conventional dose group and the control group,20 cases in each group. The control group was treated with 0. 25% ropivacaine,the conventional dose group was treated with 0. 25% ropivacaine combined with 1 μg/kg dexmedetomidine,and the high dose group was treated with 0. 25% ropivacaine combined with 2 μg/kg dexmedetomidine. Results The anesthesia time of the three groups had no significant difference（ P 〉 0. 05）. The onset time,the rate of ibuprofen usage and restlessness of the high dose group and the conventional dose group were lower than those of the control group（ P 〈 0. 05）,the duration of analgesia and recovery time of the high dose group and the conventional dose group were lower than those of the control group（ P 〈 0. 05）. The duration of analgesia,recovery time and rate of ibuprofen usage of the high dose group were better than those of the conventional dose group（ P 〈 0. 05）. The onset time,rate of restlessness in the high dose group and the conventional dose group had no significant difference（ P 〉 0. 05）. The rate of adverse reactions in the control group,the conventional dose group and the high dose group were 20. 00%,25. 00% and 30. 00%,respectively,there were no significant difference among the three groups（ P 〉 0. 05）. Conclusion High dose of dexmedetomidine combined with ropivacaine has shorter caudal block onset time,longer duration of analgesia,lower rate of restlessness and ibuprofen usage and higher safety,which is worthy of clinical promotion.