喉罩全麻复合右美托咪定及罗哌卡因骶管阻滞在小儿隐匿性阴茎手术中的效果

The effect of laryngeal mask general anesthesia combined with dexmedetomidine and ropivacaine caudal block in pediatric concealed penis surgery

目的分析喉罩全麻复合右美托咪定及罗哌卡因骶管阻滞在小儿隐匿性阴茎手术中的麻醉效果。方法选取郑州大学附属郑州中心医院2017年3月至2020年3月收治的行小儿隐匿性阴茎手术病儿110例,随机数字表法分为对照组和观察组,各55例,对照组给予喉罩全麻复合罗哌卡因骶管阻滞麻醉,观察组给予喉罩全麻复合右美托咪定及罗哌卡因骶管阻滞麻醉。比较两组病儿手术情况和麻醉药用量;比较麻醉前(T_(0)),麻醉诱导后(T_(1)),手术开始即刻(T_(2)),术中15min(T_(3)),术毕时(T_(4))病儿心率(HR)和平均动脉压(MAP)情况;比较术后即刻(T_(1)')、术后30 min(T_(2)')、术后60 min(T_(3)')儿科临床镇静评分系统(Ramsay)镇静评分和东安大略儿童医院疼痛量表(CHEOPS)镇痛评分情况。结果观察组与对照组手术时间比较,差异无统计学意义[(44.25±9.56)min比(42.05±10.25)min,P>0.05];观察组神经阻滞起效时间[(8.56±1.25)min比(13.52±1.54)min]、舒芬太尼[(2.01±0.34)µg比(3.15±0.68)µg]和丙泊酚用量[(102.35±14.35)mg比(124.35±16.54)mg]、T_(2)~T_(4)时HR水平和MAP、T_(2)'~T_(3)'时Ramsay镇静评分低于对照组,CHEOPS疼痛评分高于对照组(P<0.05)。结论喉罩全麻复合右美托咪定及罗哌卡因骶管阻滞在小儿隐匿性阴茎手术中可有效缩短神经阻滞起效时间,减少麻醉药用量,稳定血流动力学,镇静镇痛效果更佳。

Objective To analyze the anesthetic effect of laryngeal mask general anesthesia combined with dexmedetomidine and ropivacaine caudal block in children with concealed penile surgery.Methods A total of 110 patients undergoing pediatric concealed penis surgery in Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2017 to March 2020 were selected as research objects.They were randomly divided into control group and observation group,with 55 cases in each group.The control group was given laryngeal mask intubation general anesthesia combined with ropivacaine sacral block anesthesia,the observation group was given general anesthesia with laryngeal mask combined with dexmedetomidine and ropivacaine for caudal block anesthesia.The operation and anesthetic dosage were compared between the two groups;Heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T_(0)),after anesthesia induction(T_(1)),immediately after operation(T_(2)),15 min during operation(T_(3)),and at the end of operation(T_(4));Immediate postoperative(T_(1)'),30 min(T_(2)'),60 min(T_(3)')pediatric clinical sedation scoring system(Ramsay)sedation score and Eastern Ontario children's hospital pain scale(CHEOPS)analgesia score.ResultsThere was no significant difference in operation time between the two groups[(44.25±9.56)min vs.(42.05±10.25)min,P>0.05];The nerve block onset time[(8.56±1.25)min vs.(13.52±1.54)min],the dosage of sufentanil[(2.01±0.34)µg vs.(3.15±0.68)µg]and propofo l[(102.35±14.35)mg vs.(124.35±16.54)mg],the HR level at T_(2)~T_(4),the Ramsay Sedation score at map and T_(2)'~T_(3)'in the observation group were lower than those in the control group,and the Cheops pain score was higher than those in the control group(P<0.05).Conclusion Laryngeal mask general anesthesia combined with dexmedetomidine and ropivacaine caudal block can effectively shorten the onset time of nerve block in pediatric concealed penis surgery,reduce the dosage of anesthetics,stabilize hemodynamics,and have better sedative and analgesic effects.