超声引导阴茎背神经阻滞联合右美托咪定滴鼻在小儿包皮环切术中的应用

Efficacy of ultrasound-guided dorsal penile nerve block combined with intranasal dexmedetomidine in children patients undergoing Circumcision

目的观察超声引导阴茎背神经阻滞联合右美托咪定滴鼻预先镇静镇痛用于小儿包皮环切术的可行性及有效性。方法选取拟行包皮环切术患儿90例,ASA分级Ⅰ级,年龄3~10岁,体重15~45 kg,采用随机数字表法将其分为3组(n=30),右美托咪定滴鼻组(DC组)、超声引导阴茎背神经阻滞组(DL组)和超声引导阴茎背神经阻滞联合右美托咪啶滴鼻组(DD)组。3组患儿均采用七氟烷吸入喉罩全身麻醉,保留自主呼吸的方法。DL组和DD组术前行超声引导阴茎背神经阻滞,注入0.25%罗哌卡因0.2 ml/kg;DC与DD组术前30 min经鼻滴入右美托咪定1μg/kg。采用诱导期合作度量表(ICC)对患儿七氟烷吸入诱导合作程度评分,记录术中镇痛不全发生情况、苏醒时间、住院时间、术后首次使用镇痛药时间、术后24 h内镇痛药物使用情况、恶心呕吐、躁动、心动过缓及镇静过度等不良反应发生情况以及术后24 h父母满意度评分。结果与DD组比较,DC组和DL组患儿术中镇痛不全发生率增加,术后镇痛药物使用率、术后躁动及恶心呕吐发生率增加,术后首次使用镇痛药物时间缩短,苏醒时间及住院时间延长,父母满意度降低(P<0.05);与DC组比较,DL组患儿苏醒时间缩短,术后首次使用镇痛药物时间延长(P<0.05);与DL组比较,DC组和DD组ICC评分降低(P<0.05);3阻患儿心动过缓及镇静过度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右美托咪定滴鼻可安全有效的用于包皮环切术患儿,且镇痛效果显著,不良反应发生率低,缩短住院时间加速术后康复。

Objective To investigate the safety and effectivity of ultrasound-guided dorsal penile nerve block combined with intranasal exmedetomidine in children patients undergoing circumcision.Methods Ninety children patients who underwent circumcision,ASAⅠ,aged 3~10 years,weighing 15~45kg,were randomly divided into three groups,with 30 cases in each group,which were intranasal dexmedetomidine group(group DC),dorsal penile nerve block by ultrasound(group DL),dorsal penile nerve block by ultrasound combined with intranasal dexmedetomidine group(group DD).All the patients received anesthesia with sevoflurane,laryngeal mask ventilation,retained spontaneous breathing.After dorsal penile nerve block by ultrasound before the operation,the patients in group DL and group DD received 0.25%ropivacaine 0.2ml/kg,however,the patients in group DC and group DD received intranasal dexmedetomidine 1μg/kg at 30min before the operation.The cooperation degree during anesthesia induction by sevoflurane was evaluated according to the induction period cooperation scale(ICC).The incidence of analgesia insufficiency during operation,emergence time,duration of stay,duration of the first requirement for analgesics,requirement for analgesics within 24h after operation,and the adverse reactions including agitation,nausea,vomiting,bradycardia and over-sedation,as well as patient’s satisfaction score were observed and compared among the three groups.Results As compared with those in group DD,the incidence rates of analgesia insufficiency during operation,requirement for analgesics within 24h after operation,agitation,nausea and vomiting in group DC and group DD were significantly increased,and the duration of the first requirement for analgesics and satisfaction scores of patient’s parents were reduced,however,the recovery time and hospital stay were significantly prolonged(P<0.05).As compared with those in group DC,the recovery time and the time of first requirement for analgesics in group DL were significantly prolonged(P<0.05).As compared with those in group DL,the ICC scores in group DC and group DD were significantly decreased,but,there were no significant differences in the incidence rates of bradycardia and over-sedation among the three groups(P>0.05).Conclusion Ultrasound-guided dorsal penile nerve block combined with intranasal dexmedetomidine is safe and effective for the children patients undergoing circumcision,with better analgesia efficacy,less adverse reactions and shorter hospital stay.