不同优化麻醉策略用于尿道下裂整形术患儿效果的比较

Comparison of different optimized anesthesia strategies in pediatric patients undergoing hypospadias surgery

目的比较不同优化麻醉策略用于尿道下裂整形术患儿的效果。方法选取远端型尿道下裂拟行Duckett术患儿90例,ASA分级Ⅰ或Ⅱ级,年龄1~6岁,体重10~25 kg,采用随机数字表法将其分为3组(n=30):骶管阻滞联合全麻组(CG组)、神经刺激仪引导阴部神经阻滞联合全麻组(PG组)和超声引导阴茎背神经阻滞联合全麻组(DPG组)。全麻方法:均采用丙泊酚-芬太尼麻醉诱导,喉罩通气,保留自主呼吸,七氟烷麻醉维持的方法。各组进行相应区域阻滞,用药情况:CG组0.25%罗哌卡因1 ml/kg、PG组0.25%罗哌卡因0.25 ml/kg、DPG组0.25%罗哌卡因0.15 ml/kg。记录罗哌卡因用量、术中镇痛不全发生情况、苏醒时间、PACU停留时间、术后首次使用镇痛药时间、术后24 h内镇痛药物使用情况、术后躁动、恶心呕吐和下肢运动阻滞的发生情况以及术后24 h时父母满意度评分。结果与CG组比较,PG组和DPG组罗哌卡因用量减少,术后首次使用镇痛药时间延长,术后镇痛药物使用率降低,PACU停留时间缩短,运动阻滞发生率降低,父母满意度评分升高,DPG组术后恶心呕吐发生率降低(P<0.05);与PG组比较,DPG组罗哌卡因用量减少,PACU停留时间缩短(P<0.05)。3组术中镇痛不全发生率(DPG组3%)、术后躁动发生率比较差异无统计学意义(P>0.05)。结论超声引导阴茎背神经阻滞联合全麻镇痛效果显著,且安全性较高,用于尿道下裂整形术患儿的效果优于骶管阻滞联合全麻和神经刺激仪引导阴部神经阻滞联合全麻。

Objective To compare the different optimized anesthesia strategies in pediatric patients undergoing hypospadias surgery.Methods Ninety pediatric patients with distal hypospadias undergoing Duckett operation,of American Society of Anesthesiologists physical statusⅠorⅡ,aged 1-6 yr,weighing 10-25 kg,were divided into 3 groups(n=30 each)using a random number table method:caudal block combined with general anesthesia group(group CG),neurostimulator-guided pudendal nerve block combined with general anesthesia group(group PG)and ultrasound-guided dorsal penile nerve block combined with general anesthesia group(group DPG).Anesthesia was induced with propofol-fentanyl,patients were ventilated through the laryngeal mask and maintained spontaneous breathing,and anesthesia was maintained with sevoflurane.The corresponding regional block was performed in each group,and block was performed with 0.25%ropivacaine 1,0.25 and 0.15 ml/kg in CG,PG and DPG groups,respectively.The consumption of ropivacaine,occurrence of insufficient analgesia during operation,emergence time,duration of post-anesthesia care unit stay,time of the first requirement for analgesics,requirement for analgesics within 24 h after operation,occurrence of postoperative agitation,nausea and vomiting and lower extremity motor block,and patients′satisfaction score at 24 h after operation were recorded.Results Compared with group CG,the consumption of ropivacaine was significantly reduced,the time of the first requirement for analgesics was prolonged,the postoperative requirement for analgesics was decreased,duration of post-anesthesia care unit stay was shortened,the incidence of lower extremity motor block was decreased,and patients′satisfaction score was increased in group PG and group DPG,and the incidence of nausea and vomiting was decreased in group DPG(P<0.05).Compared with group PG,the consumption of ropivacaine was significantly reduced,and the time of the first requirement for analgesics was shortened in group DPG(P<0.05).There was no significant difference in the incidence of insufficient analgesia during operation(3%in group DPG)and incidence of postoperative agitation among the three groups(P>0.05).Conclusion Ultrasound-guided dorsal penile nerve block combined with general anesthesia provides significant efficacy with a higher safety,and the efficacy is better than that of caudal block combined with general anesthesia and neurostimulator-guided pudendal nerve block general anesthesia when used for pediatric patients undergoing hypospadias surgery.