不同麻醉方式对隐匿阴茎手术麻醉效果的对比研究

Effects of different anesthetic modes upon children with concealed penis

目的探讨不同麻醉方式在隐匿阴茎手术中的麻醉镇痛效果。方法本研究共收集浙江大学医学院附属儿童医院行隐匿阴茎手术患儿90例作为研究对象,随机分为3组,即静脉麻醉复合罗哌卡因利多卡因骶管阻滞组(Ⅰ组)、静脉麻醉复合罗哌卡因骶管阻滞组(Ⅱ组)、喉罩插管全麻复合罗哌卡因骶管阻滞组(Ⅲ组)。监测术中生命体征,记录麻醉诱导至手术开始时间,运动阻滞评分、PACU停留时间、术后各时点疼痛评分、术后镇痛药给药次数、麻醉费用等。结果3组患儿均按术前制定的麻醉方案进行,麻醉效果满意,术中生命体征平稳。麻醉诱导至手术开始时间3组间无统计学差异(P=0.58)。Ⅰ、Ⅱ组手术完成后患儿送往PACU,Ⅲ组手术完成后拔出喉罩后送往PACU。术中加用丙泊酚人数Ⅰ、Ⅱ组无统计学差异(P=0.573)。Ⅲ组术中采用七氟烷(1%~1.5%)吸入维持。术后PACU停留时间3组间无统计学差异(P=0.458);术后镇痛药物使用和术后疼痛评分3组间无统计学差异(P>0.05)。相对于Ⅱ、Ⅲ组,Ⅰ组在术后30 min存在运动阻滞(P<0.001)。术后恶心呕吐的发生率3组间无统计学差异(P=0.455),术后Ⅲ组有7例(23.3%)出现苏醒期躁动、3例(10%)出现分泌物增多。结论静脉麻醉复合罗哌卡因骶管阻滞用于小儿隐匿阴茎手术麻醉效果佳,术后镇痛完善,副作用少,可加快手术室的利用率,加速患儿的术后康复。

Objective To explore the effects of different anesthetic modes on anesthetic efficacy during and after operations of concealed penis in children.Methods A total of 90 children undergoing concealed penile surgery were prospectively enrolled and randomly divided into intravenous anesthesia plus ropivacaine and lidocaine sacral anesthesia group(groupⅠ),intravenous anesthesia plus ropivacaine sacral anesthesia group(groupⅡ)and laryngeal mask anesthesia plus ropivacaine sacral anesthesia group(groupⅢ).Vital signs in different groups were monitored intraoperatively.Time from induction of anesthesia to beginning of operation,postoperative dosing frequency of analgesics,postoperative pain score at each timepoint,motor blockage score,duration of postanesthesia care unit(PACU),anesthetic cost and hospitalization length were recorded.Results The efficacy of anesthesia was satisfactory in all three groups and the anesthetic protocol remained unchanged during operation.No significant difference existed in time from induction of anesthesia to beginning of operation among three groups(P=0.58).Children in groupsⅠandⅡwere transferred postoperatively into PACU while those in groupⅢdid so after removing laryngeal mask.Propofol consumed intraoperatively showed no difference between groupsⅠandⅡ(P=0.573).The concentration of sevoflurane was maintained at 1%-1.5%in groupⅢ.PACU duration,pain score and postoperative use of analgesics showed no difference among three groups.As compared with groupsⅡandⅢ,groupⅠhad motor blockage at 30 min post-operation(P<0.001).No difference was observed in postoperative nausea and vomiting(PONV)among three groups(P=0.455).There were delirium(n=7)and intensified excretions(n=3)while no symptom was observed in another two groups.The cost of anesthesia in groupⅢnearly doubled of those in groupsⅠandⅡ.No difference existed in hospitalization length among three groups.Conclusion Ropivacaine caudal blockage alone may achieve satisfactory anesthesia during concealed penis surgery,reduce the intubation-related complications,quicken the utilization of operating room and accelerate the postoperative recovery of children.