小儿腹腔镜疝手术实施右美托咪定注射液滴鼻复合七氟醚麻醉的镇痛效果

Analgesic effect of dexmedetomidine injection nasal drip combined with sevoflurane anesthesia in pediatric laparoscopic hernia surgery

目的评价小儿腹腔镜疝手术实施右美托咪定滴鼻复合七氟醚麻醉的镇痛效果及安全性。方法选取100例腹股沟疝患儿为研究对象,采用随机数字表法分为对照组(n=50)和试验组(n=50)。所有患儿均采用腹腔镜疝手术进行治疗,且均行常规麻醉,在此基础上,对照组采用2%~3%七氟醚雾化吸入进行麻醉,试验组在对照组的基础上,在术前1 h经两侧鼻孔滴入1.0μg·kg^(-1)盐酸右美托咪定注射液。2组均观察3 d。比较2组麻醉效果、生命体征、炎症、氧化应激指标、镇痛、镇静情况及药物不良反应发生情况。结果试验组和对照组麻醉诱导后(T1)、手术开始后10 min(T2)、术后10 min(T3)心率(HR)分别为(115.73±14.37),(92.71±9.73),(95.47±9.63)和(126.58±15.84),(109.89±11.59),(115.84±13.72)time·min^(-1);平均动脉压(MAP)分别为(80.53±8.84),(78.99±8.20),(79.30±8.74)和(85.84±9.37),(92.30±9.69),(80.83±8.32)mmHg;试验组和对照组苏醒时血清白细胞介素-6(IL-6)水平分别为(6.40±1.53)和(9.47±1.82)pg·L^(-1);血清超氧化物歧化酶(SOD)水平分别为(469.83±51.20)和(384.28±43.76)mmol·L^(-1);试验组和对照组手术完成时及术后1和2 h东安大略儿童医院疼痛评分量表(CHEOPS)评分分别为(1.68±0.47),(2.33±0.56),(2.71±0.67)和(2.34±0.68),(2.93±0.73),(3.53±0.82)分;躁动评分分别为(2.01±0.21),(1.53±0.17),(0.93±0.11)和(2.48±0.27),(1.76±0.18),(0.98±0.12)分,2组上述指标比较,差异均有统计学意义(均P<0.05)。观察期间,试验组和对照组总药物不良反应发生率比较无统计学差异(P>0.05)。结论右美托咪定注射液滴鼻复合七氟醚对腹腔镜疝手术患儿进行治疗,具有较好的镇痛、镇静和麻醉效果,值得在临床推广。

Objective To evaluate the analgesic effect and safety of dexmedetomidine nasal drip combined with sevoflurane anesthesia in laparoscopic hernia operation in children.Methods A total of 100 children with inguinal hernia were divided into control group(n=50)and treatment group(n=50)by random number table method.All the children were treated by laparoscopic hernia operation,and all of them were given routine anesthesia.On this basis,the control group was given 2%~3%sevoflurane aerosol inhalation for anesthesia,and the treatment group was given 1.0μg·kg^(-1)dexmedetomidine hydrochloride injection was dripped through both nostrils 1 h before operation on the basis of control group.Both groups were observed for 3 d.The anesthetic effect,vital signs,inflammation,oxidative stress indexes,analgesia,sedation and adverse reactions were compared between the two groups.Results The heart rate(HR)of the treatment group and the control group at after anesthesia induction(T1),10 min after operation(T2)and 10 min after operation(T3)were(115.73±14.37),(92.71±9.73),(95.47±9.63)and(126.58±15.84),(109.89±11.59),(115.84±13.72)time·min^(-1),respectively;mean arterial pressure(MAP)were(80.53±8.84),(78.99±8.20),(79.30±8.74)and(85.84±9.37),(92.30±9.69),(80.83±8.32)mm Hg,respectively.The level of serum interleukin-6(IL-6)of the treatment group and the control group at wake up were(6.40±1.53)and(9.47±1.82)pg·L^(-1),respectively;the level of serum superoxide dismutase(SOD)were(469.83±51.20)and(384.28±43.76)mmol·L^(-1),respectively.The score of Eastern Ontario Children’s Hospital Pain Score Scale(CHEOPS)of the treatment group and the control group at the end of the operation,1 and 2 h after operation were(1.68±0.47),(2.33±0.56),(2.71±0.67)and(2.34±0.68),(2.93±0.73),(3.53±0.82)points,respectively;score of restlessness were(2.01±0.21),(1.53±0.17),(0.93±0.11)and(2.48±0.27),(1.76±0.18),(0.98±0.12)points,respectively.Compared with the above indexes,the differences between the two groups were statistically significant(all P<0.05).During the observation period,there was no significant difference in the incidence of total adverse drug reactions between the treatment group and the control group(P>0.05).Conclusion Dexmedetomidine injection nasal drop combined with sevoflurane in the treatment of children undergoing laparoscopic hernia surgery has good analgesic,sedative and anesthetic effects,which is worthy of clinical promotion.