右美托咪定辅助用于小儿尿道下裂修补术后镇痛的效果观察

Effect of Dexmedetomidine on Postoperative Analgesia in Children with Repair of Hypospadias

目的观察右美托咪定复合芬太尼用于尿道下裂修补术患儿术后镇痛的效果及安全性。方法选择全麻下择期行尿道下裂修补术的患儿60例,随机分为F组和D组,各30例。F组给予芬太尼0.3μg/(kg·h),D组给予右美托咪定0.05μg/(kg·h)+芬太尼0.2μg/(kg·h),所有患者手术结束前30 min,给予芬太尼负荷剂量1μg/kg。手术结束前即刻连接一次性恒速机械镇痛泵,泵注速率2 ml/h。记录连接镇痛泵后2、4、8、12、24及48 h的Wong-Baker脸谱疼痛评分和Ramsay镇静评分,补救镇痛次数以及术后心动过缓、低血压、恶心呕吐等不良反应发生情况。结果与F组比较,D组患儿补救镇痛次数、恶心呕吐及躁动发生率降低,患儿2、4、8、12、24及48 h的Wong-Baker脸谱疼痛评分降低、而Ramsay镇静评分增高,差异有统计学意义(P<0.05),两组患者在镇痛过程中均未出现心动过缓及低血压。结论右美托咪定辅助用于小儿尿道下裂术后镇痛能提供较好镇痛效果和较佳镇静舒适度,减少不良反应的发生。

Objective To observe the effect and safety of dexmedetomidine combined with fentanyl for postoperative analgesia in children with hypospadias repair.Methods60patients with elective hypospadias under general anesthesia were randomly divided into group F and group D,30cases each.Group F was given fentanyl0.3μg/(kg·h),group D was given dexmedetomidine0.05μg/(kg·h)+fentanyl0.2μg/(kg·h),all patients before the end of surgery30min,fentanyl was given a loading dose of1μg/kg.A one-time constant-speed mechanical analgesia pump was connected immediately before the end of the operation,and the pumping rate was2ml/h.Wong-Baker facial pain score and Ramsay sedation score were recorded at2,4,8,12,24,and48h after analgesia pump,Remedy the number of analgesic and adverse reactions such as postoperative bradycardia,hypotension,nausea and vomiting.Results Compared with group F,the number of remedies for analgesia,nausea,vomiting,and agitation were lower in group D.The Wong-Baker facial pain scores were lower at2,4,8,12,24,and48h,and the Ramsay sedation score was lower,the difference was statistically significant(P<0.05).There was no bradycardia or hypotension during the analgesia in both groups.Conclusion Dexmedetomidine can improve the analgesic effect and better sedative comfort after pediatric hypospadias and reduce the incidence of adverse reactions.