骶管连续硬膜外阻滞对小儿手术镇痛效果分析

Analgesic effect of continuous epidural block through sacral canal in pediatric surgery

目的探讨经骶管连续硬膜外阻滞镇痛对小儿会阴及腹部手术的效果。方法选取2016年7月至2017年12月在浙江省台州医院住院行小儿会阴部或腹部手术的儿童患者60例,分为静吸组和实验组。静吸组给予常规静脉和吸入性麻醉药联合方法,在手术过程中根据需要适当追加镇痛药物。实验组给予全麻诱导之后,再经骶裂孔将硬膜外滴管置入,给予1%利多卡因2mL后,若患者没有蛛网膜下腔阻滞的临床表现及生命体征平稳,则再继续注入0.25%的罗哌卡因,手术过程中,每隔1h追加1次罗哌卡因。评估两组患儿在手术后1、4、8、12、24、36、48、72h的FLACC疼痛评分及Ramsay镇静评分。结果在FLACC疼痛评分方面,实验组在每个时间段疼痛评分均显著低于静吸组(t值分别为27.332、32.141、23.662、41.504、28.641、37.620、25.141、36.652,均P<0.05)。在Ramsay镇静评分方面,实验组从术后8h开始,每个时间段镇静评分均显著低于静吸组,差异均有统计学意义(t值分别为25.687、32.161、20.985、44.230、34.255、28.338,均P<0.05)。结论在小儿会阴及腹部手术后,采用经骶管连续硬膜外阻滞的方式能显著降低患儿的疼痛感,有良好的镇静效果,值得在临床广泛应用。

Objective To explore the analgesic effect of continuous epidural block through sacral canal in perineum and abdominal operation of children.Methods Sixty children receiving pediatric perineum or abdominal surgery in Taizhou Hospital from July 2016 to December 2017 were selected and divided into inhalation group and experimental group.Patients in inhalation group were given a combination of conventional intravenous and inhalation anesthetics,and analgesic drugs were appropriately added as needed during surgery.Patients in experimental group were implanted with epidural catheter through sacral hole after induction of general anesthesia.After administration of 2 mL of 1% lidocaine,if patient had no clinical manifestations of subarachnoid block and vital signs were stable,0.25% ropivacaine was given.Ropivacaine was added once every hour during surgery.FLACC pain scores and Ramsay sedation scores at 1,4,8,12,24,36,48,and 72 hours after surgery were assessed in both groups.Results In terms of FLACC pain scores,pain scores at each time point in experimental group were significantly lower than those in inhalation group（t value was 27.332,32.141,23.662,41.504,28.641,37.620,25.141 and 36.652,respectively,all P〈0.05）.In terms of Ramsay sedation scores,sedation scores in experimental group at each time point starting from 8 hours after surgery were significantly lower than those in inhalation group,and differences were statistically significant（t value was 25.687,32.161,20.985,44.230,34.255 and 28.338,respectively,all P〈0.05）.Conclusion Continuous epidural block through sacral canal can significantly reduce pain of patients in pediatric perineal and abdominal surgery.It has good sedative effect and is worthy of wide clinical application.