腹横肌平面阻滞联合帕瑞昔布钠对小儿苏醒期躁动的影响研究

The effect of transverse abdominal plane block combined with parecoxib sodium on emergence agitation in children:a randomized clinical study

目的观察腹横肌平面阻滞联合帕瑞昔布钠对小儿苏醒期躁动(emergency agitation,EA)的影响。方法选择2018年12月—2019年12月于蚌埠医学院第一附属医院普外科行腹腔镜疝囊高位结扎术的120例患儿,根据随机数字表法随机分为4组,神经阻滞联合帕瑞昔布钠组(TP组)、帕瑞昔布钠组(P组)、神经阻滞组(T组)和对照组(C组),各30例,TP、P组麻醉诱导时静注帕瑞昔布钠0.9 mg/kg,C、T组静注等量生理盐水,诱导后,TP、T组腹横肌平面注射1 mL/kg 0.25%罗哌卡因,C、P组腹横肌平面注射等量生理盐水,分别记录术中循环、苏醒期躁动、术后镇静程度及术后24 h的不良反应。结果4组患儿手术总体情况差异无统计学意义(均P>0.05),TP组、P组和T组较C组术中循环更稳定(均P<0.05),TP组较P组、T组术中循环更稳定(均P<0.05),TP组、P组、T组和C组躁动发生率分别为16.67%、26.67%、26.67%和53.33%,TP组、P组和T组较C组患儿术后各时点疼痛评分(FLACC)均明显降低(均P<0.05),而3组患儿术后Ramsay评分较C组均升高(均P<0.05);与P组、T组比较,TP组T5、T6、T7时刻FLACC评分均降低(均P<0.05),T5时刻Ramsay评分升高(均P<0.05);4组患儿术后无苏醒延迟、嗜睡等不良反应。结论腹横肌平面阻滞联合帕瑞昔布钠能显著抑制小儿术后躁动的发生,术中循环更稳定,具有临床参考意义。

Objective To discuss the effect of transverse abdominal plane block combined with parecoxib sodium on the incidence of emergency agitation(EA)in pediatric laparoscopic hernia repair surgery.Methods A total of 120 chil-dren,aged from 1 to 3 years,scheduled for hernioplasty were randomly divided into 4 groups(30 cases in each group),transverse abdominal plane block combined with parecoxib sodium group(TP group),transverse abdominal plane block group(T group),parecoxib group(P group)and control group(C group).The TP group and P group at the time of an-esthesia induction were intravenously injected using 0.9 mg/kg parecoxib respectively.After the induction,the children in TP group and T group were injected with 1 mL/kg 0.25%ropivacaine in the transverse abdominal muscle plane,and the children in P group and C group were injected with the same amount of normal saline.The operation condition,emer-gence agitation,pain,sedation and adverse reaction after 24 h of operation were recorded.Results There was no signif-icant difference in the duration of anesthesia,operation,respiratory recovery and extubation among the four groups(P>0.05).HR and MAP of TP group,P group and T group were lower than those of C group during the operation(P<0.05),which were lower than those of P and T groups(all P<0.05).The incidences of the agitation in P group and T group were lower than that in C group(all P<0.05).The incidence of the agitation in TP group,P group,T group and C group was 16.67%,26.67%,26.67%and 53.33%,respectively.There were significant differences between the four groups(all P<0.05).Compared with the FLACC and Ramsay scores in C group,which in P and T groups de-creased significantly(all P<0.05).Compared with the P group and T group,the FLACC scores in groups at T5,T6 and T7 decreased(all P<0.05),and the Ramsay scores at T5 was significantly higher than that in p group and T group(all P<0.05).There were no adverse reactions such as delayed recovery and drowsiness in 4 groups.Conclusion Transverse abdominal plane block combined with parecoxib sodium can significantly reduce the incidence of EA in chil-dren,with more stable intraoperative circulation and good safety,which has important clinical reference significance.