超声引导椎旁神经阻滞在右腋下切口小儿先心手术术后镇痛效果观察

摘要

目的 观察超声引导椎旁神经阻滞用于小儿先心手术术后的镇痛效果.方法 选择60例择期行经右腋下切口室间隔缺损修补术患儿,随机均分为全麻静脉自控镇痛复合椎旁神经阻滞镇痛组(P组)和单纯全麻静脉自控镇痛组(N组).P组患儿手术结束后在超声引导下于开胸侧所在肋间的椎旁间隙注射0.25%盐酸罗哌卡因0.5 ml/kg,同时使用静脉自控镇痛泵;N组只使用静脉自控镇痛.观察并记录术后1,4, 8,12,24,48 h的HR、MAP,FLACC镇痛评分及Ramsay镇静评分,舒芬太尼用量,镇痛泵的按压次数,术后恶心呕吐、呼吸抑制等不良反应发生率.结果 两组术后各时点HR、MAP对比,P＞0.05,差异不具有统计学意义;P组FLACC镇痛评分及Ramsay镇静评分低于N组,P＜0.05,差异具有统计学意义;P组舒芬太尼用量,镇痛泵的按压次数少于N组;术后镇痛不良反应发生率对比,P＞0.05,差异不具有统计学意义.结论 超声引导椎旁神经阻滞应用于右腋下小儿先心病手术术后镇痛安全有效.%Objective Observation the effect of postoperative analgesia by ultrasound guidance para vertebral block of right oxter incision in children with congenital heart disease operation.Methods Selected 60 patients undergoing elective through right subaxillary incision for children with ventricular septal defect repair randomly were divided into the intravenous general anesthesia self-control analgesia compound near the vertebral nerve block analgesia group (P group) andsimple intravenous general anesthesia self-control analgesia group (N group). P group after the surgery under guided by ultrasound in children open vertebral side clearance between the lateral thoracic rib in 0.25% hydrochloric acid,ropivacaine injection paid 0.5 ml/kg, using intravenous self-control analgesia pump at the same time, N group using only intravenous self-control analgesia. Observe and record postoperative,4, 8, 12, 24, 48 hours HR, MAP, FLACC analgesic scores and ramsay sedation score, dosage of sufentanil and analgesia pump pressure, incidence of postoperative nausea and vomiting, adverse reactions such as respiratory depression.Results Compared two groups of postoperative various point HR, MAP,P＞0.05, was no difference had statistically significance. P group FLACC analgesic scores and Ramsay sedation score lower than N group,P＜0.05, was difference had statistically significance. P group of sufentanil dosage, press the number of analgesia pump is less than that of N group,P＞0.05, was no difference had statistically significance. incidence of postoperative analgesia adverse reaction. Conclusion By the vertebral nerve block guided by ultrasound is applied to right armpit children with congenital heart disease surgery postoperative analgesia is safe and effective.