右美托咪定骶管阻滞对小儿泌尿外科手术围术期应激反应和苏醒质量的影响

Influence on stress response and recovery quality of Dexmedetomidine in sacral block for urological surgery of perioperative children

目的探讨右美托咪定用于小儿骶管阻滞,在泌尿外科手术中对围术期应激反应的抑制和对苏醒质量的影响。方法选择郑州大学附属儿童医院2018年3月—2019年12月间收治的160例泌尿外科手术患儿,年龄3~7岁。随机数字表法分为2组:1μg/kg右美托咪定+0.25%罗哌卡因骶管阻滞组(DR组;n=80);0.25%罗哌卡因骶管阻滞组(R组;n=80)。丙泊酚诱导置入喉罩,骶管穿刺注入1 mL/kg各组药物,观察24 h去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(COS)水平、术中循环系统不良事件发生率、苏醒期躁动发生率、苏醒时间、骶管阻滞起效时间、镇痛持续时间及住院天数。结果与R组相比:DR组NE、E、COS从切皮至术后24 h均降低(P<0.05),术中心动过速和高血压、苏醒期躁动发生率降低,骶管阻滞起效时间缩短,镇痛持续时间延长,住院时间缩短(P<0.05);结论右美托咪定骶管应用降低应激和炎症反应,循环稳定,麻醉不良反应少,且起效快,延长了术后镇痛时间,不影响苏醒时间,利于术后康复。

Objective To explore the effects of stress response and recovery quality of dexmedetomidine sacral block for urological surgery of perioperative children.Methods Totally 160 children aged 3~7yr,scheduled for urological surgery,were divided into two groups by random number table method:group D(n=80)was injected with 1μg·kg-1 dexmedetomidine and 0.25%ropivacaine mixture;Group R(n=80)was injected with 0.25%ropivacaine.After induction with propofol and LMA insertion,1mL·kg-1 of predefined drugs were caudal injected.Observed indicators:the level of noradrenaline(NE),adrenaline(E),cortisol(COS)in 24-hour;incidence of adverse events in the circulatory system during surgery,the incidence of agitation during recovery,the wake-up time,the onset time of the caudal block,analgesia maintenance time,hospitalization days.Results Compared with group R,the level of NE,E,COS in group D was decreased from the time of incision to 24 h after operation(P<0.05).The incidence of tachycardia,hypertension,agitation during the recovery,were lower.The onset time of caudal block was shortened.The duration of analgesia was prolonged.Discharge time was reduced(P<0.05).Conclusion Dexmedetomidine in caudal block can reduce stress,inflammatory response,surgical complications and keep circulatory system stable,meanwhile it can also accelerate the onset of effect,without influenceing the recovery time,prolong the postoperative analgesia time,which gets recovery fast.