不同剂量右美托咪定腹横肌平面阻滞用于小儿全麻腹腔镜阑尾切除术的效果对比

Comparison of the Effects of Different Doses of Dexmedetomidine for Transversus Abdominis Plane Block in Children Undergoing Laparoscopic Appendectomy under General Anesthesia

目的探讨不同剂量右美托咪定(dexmedetomidine,Dex)腹横肌平面阻滞(transversus abdominis plane block,TAPB)用于小儿全麻腹腔镜阑尾切除术的效果。方法方便选取2019年6月—2021年5月于福建省妇幼保健院就诊的阑尾切除患儿128例,按随机数表法分为对照组和观察组,各64例。对照组给予0.5μg/kg Dex+罗哌卡因,观察组给予1.0μg/kg Dex+罗哌卡因,对比两组血流动力学指标、镇静及疼痛情况、拔管、复苏室(PACU)滞留时间及24 h内止痛药使用情况。结果两组心率(HR)、平均动脉压(MAP)水平对比,差异无统计学意义(P>0.05);观察组术后疼痛评估量表(FLACC)(1.84±0.53)分明显低于对照组(2.06±0.62)分,差异有统计学意义(t=2.158,P<0.05);两组儿科临床镇静评分系统(Ramsay)对比,差异无统计学意义(P>0.05);观察组拔管时间、PACU滞留时间均短于对照组,但两者对比差异无统计学意义(P>0.05);观察组术后24好内布洛芬使用率(32.81%)显著低于对照组(84.37%),差异有统计学意义(χ^(2)=35.067,P<0.05)。结论相较于0.5μg/kg Dex+罗哌卡因TAPB,1.0μg/kg Dex可延长全麻腹腔镜阑尾切除患儿术后疼痛阻滞时间,减少术后止痛药的使用,且不影响血流动力学稳定及延长苏醒和拔管时间。

Objective To investigate the effect of different doses of dexmedetomidine(Dex)transversus abdominis plane block(TAPB)in children undergoing laparoscopic appendectomy under general anesthesia.Methods A total of 128 children with appendectomywere selected in Fujian Maternal and Child Health Hospital from June 2019 to May 2021,according to random number table method,they were divided into control group and observation group,64 cases in each group.The control group was given 0.5μg Dex+ropivacaine,and the observation group was given 1.0μg Dex+ropivacaine.The hemodynamic indexes,sedation and pain,extubation,resuscitation chamber(PACU)retention time and the use of painkillers within 24 h were compared between the two groups.Results There was no significant difference in heart rate(HR)and mean arterial pressure(MAP)levels between the two groups(P>0.05).The postopera⁃tive pain assessment scale(1.84±0.53)points score(FLACC)in the observation group was significantly lower than that in the control group(2.06±0.62)points,the difference was statistically significant(t=2.158,P<0.05).There was no sig⁃nificant difference in the pediatric clinical sedation scoring system(Ramsay)between the two groups(P>0.05).The ex⁃tubation time and PACU retention time of the observation group were shorter than those of the control group,but the difference between them was not statistically significant(P>0.05).The use rate of ibuprofen(32.81%)in the observa⁃tion group with in 24 hours after operation was significantly lower than that in the control group(84.37%),the differ⁃ence was statistically significant(χ^(2)=35.067,P<0.05).Conclusion Compared with 0.5μg/kg Dex+ropivacaine TAPB,1.0μg/kg Dex can prolong the postoperative pain block time in children with laparoscopic appendectomy under gen⁃eral anesthesia and reduce the use of postoperative analgesics and will not affect the hemodynamic stability and pro⁃long the recovery and extubation time.