右美托咪定与吗啡在骶管阻滞麻醉中对小儿隐匿型阴茎延长术术后镇痛的影响

Effect of Dexmedetomidine and Morphine on Postoperative Analgesia of Concealed Penile Lengthening in Children during Sacral Block Anesthesia

目的:探究右美托咪定与吗啡在骶管阻滞麻醉中对小儿隐匿型阴茎延长术术后镇痛的影响。方法:选择2019年4月-2020年10月于本院接受隐匿型阴茎延长术治疗的70例患儿为研究对象,按照其麻醉方式的差异将其区分为右美托咪定组(D组,40例)与吗啡组(M组,30例),D组采用右美托咪定实施骶管阻滞麻醉,M组使用吗啡进行骶管阻滞麻醉。比较两组患儿的手术时间、术中液体入量、麻醉起效时间、术后镇痛效果,记录对比两组患儿围手术期不同时间点的平均动脉压、心率、血氧饱和度以及Ramsay镇静评分,最后统计两组患儿的不良反应发生率。结果:两组患儿手术时间、术中液体入量比较,差异均无统计学意义(P>0.05),D组麻醉起效时间明显短于M组(P<0.05)。手术开始15 min(T3)和苏醒时(T4),D组患儿的平均脉压差和心率均低于M组,血氧饱和度均高于M组(P<0.05)。术后3、12、24、48 h,两组患儿的疼痛评分比较,差异均无统计学意义(P>0.05),但术后3、12 h,D组Ramsay评分均低于M组(P<0.05)。D组和M组患儿术后24 h内不良反应发生率比较,差异有统计学意义(P<0.05)。结论:对实施隐匿型阴茎延长术患儿应用右美托咪定与吗啡开展骶管麻醉镇痛效果均值得肯定,但右美托咪定在稳定患儿术中血流动力学指标以及术后镇静方面效果更佳,建议应用右美托咪定对隐匿型阴茎延长术患儿开展麻醉。

Objective:To explore the analgesic effect of Dexmedetomidine and Morphine sacral canal block anesthesia in children with concealed penile lengthening surgery.Method:A total of 70 children who received concealed penile lengthening surgery in our hospital from April 2019 to October 2020 were selected as the research objects,and they were divided into Dexmedetomidine group(group D,40 cases)and the Morphine group(group M,30 cases)according to the difference of their anesthesia methods,the group D was given Dexmedetomidine for sacral block anesthesia,and the group M was given Morphine for sacral block anesthesia.The operation time,intraoperative fluid intake,anesthesia onset time and postoperative analgesia effect of the two groups were compared.The mean arterial pressure,heart rate,blood oxygen saturation and Ramsay sedation score of the two groups at different time points during the perioperative period were recorded and compared.Finally,the incidence of adverse reactions of the two groups of children was counted.Result:There were no statistically significant differences in operation time and intraoperative fluid intake between the two groups(P>0.05),the onset time of anesthesia in group D was significantly shorter than that in group M(P<0.05).15 min after operation(T3)and at recovery(T4),the mean pulse pressure and heart rate in group D were lower than those in group M,and the blood oxygen saturation in group D was higher than that in group M(P<0.05).At 3,12,24 and 48 h after surgery,there were no significant differences in pain scores between the two groups(P>0.05),but the Ramsay scores of group D were lower than those of group M at 3 and 12 h after operation(P<0.05).There was significant difference in the incidence of adverse reactions between group D and group M within 24 h after operation(P<0.05).Conclusion:The effect of Dexmedetomidine and Morphine on the anesthesia and analgesia of the sacrocanal in children undergoing oceptive penis lengthing surgery are worth affirming,but the effect of Dexmedetomidine is better in stabilizing the intraoperative hemodynamic indexes and postoperative sedation in children,so it is suggested to use Dexmedetomidine in the anesthesia of children undergoing oceptive penis lengthing surgery.