右美托咪定非静脉给药途径在儿科下腹手术术后镇痛的应用

摘要

目的:研究右美托咪定非静脉给药途径在儿科下腹术后镇痛的应用.方法:搜集我院儿科拟行下腹择期手术的患儿60例,随机分为A、B、C三组,每组各20例.B组于术前30min右美托咪定1ug/kg滴鼻,A,C组等容积生理盐水滴鼻.三组患儿均给于阿托品0.01~0.02mg/kg,利多卡因1mg/kg,丙泊酚2mg/kg,七氟醚6~8%,氧流量2L/min,待患儿睫毛反射消失置入喉罩,将七氟醚降到1~2%.A组和B组患儿骶管阻滞成功后注入0.25%罗哌卡因1mL/kg,C组给予0.25%罗哌卡因1mL/kg+右美托咪定1ug/kg,骶管阻滞给予药物总量20mL封顶.记录患儿的一般资料.记录手术时间,诱导时间,拔喉罩时间和苏醒时间.记录心动过缓、苏醒延迟、喉痉挛、尿储留和苏醒期躁动评分.记录术后4,8,12,16,20,24h镇痛评分,镇静评分,计算各组镇痛时间.结果:三组患儿一般状况差异无统计学意义(P>0.05).三组手术时间,拔喉罩时间,苏醒时间差异不存在统计学意义(P>0.05),B组的诱导时间短于A组和C组(P<0.05).三组患儿均无心动过缓、苏醒延迟和尿储留的发生,A组喉痉挛的发生和躁动评分高于B和C组,B,C组的镇痛时间比A组延长,C组最长(P<0.05).术后4h镇痛评分均小于4分,镇静评分为2~3分,B,C组8h的镇痛镇静评分低于A组(P<0.05),C组12,16,20h的镇静,镇痛评分低于A,B组(P<0.05);术后24h镇痛镇静评分差异无统计学意义(P>0.05).结论:右美托咪啶滴鼻给药诱导迅速且有早期术后镇痛镇静的作用,右美复合罗哌卡因骶管阻滞术后镇痛时间明显延长,苏醒期不良反应明显减少.%Objective:To investigate the effect of dexmedetomidine intravenous administration on post-operative analgesia in pediatric patients undergoing abdominal surgery. Methods:60 patients who were under-going the general anesthesia for lower abdomen surgery were randomly devided into there groups, each group 20 cases. Patients in group B were received dexmedetomidine 1ug/kg nasal drops before operation 30min;Pa-tients in group A, C were received volume normal saline nasal drops. The three groups were given atropine 0. 01-0.02mg/kg, lidocaine 1mg/kg, propofol 2mg/kg, sevoflurane 6-8%, oxygen flow 2L/min, waiting for the eyelash reflex disappeared, placed the laryngeal mask, sevoflurane dropped to 1-2%. In group A and group B, 0.25% ropivacaine 1ml/kg was injected after the success of sacral block, group C was given 0.25%ropivacaine 1ml/kg+dexmedetomidine 1ug/kg, sacral block was given total amount of 20ml cap. 1. Each pa-tient general information respectively were record;2. The time of operation, induction, extubation and anes-thesia awake were recorded;3. The adverse events such as bradycardia, delayed awakening, laryngismus, u-rine retention were and awakening period agitation score were recorded. 4. Postoperative 4, 8, 12, 16, 20, 24 hours analgesic score, sedation score and analgesia time were recorded. Results:1. The general situation have no statistical significance ( P>0.05);2. The time of operation, extubation and anesthesia awake have no sta-tistical significance ( P>0.05) , the induction time of B group are shorter than A and C groups ( P<0.05);3. All the three groups have no hypoxemia, delayed awakening and urine retentionwere;Compared with group B and C, the emergence laryngismus and awakening period agitation score were higher in group A ( P<0.05);the analgesia time were shorter, group C was the longest. 4. All the analgesic score of the three groups were less than 4 points, sedation score for 2-3 minute in postoperative 4 h. Compared with group A, analgesic and sedation score of the group B and C are lower in postoperative 8 h( P<0.05) . Compared with group A and B, analgesic and sedation score of the group C were lower in postoperative 12, 16, 20h ( P<0.05) . There was no statistical significance in postoperative 24h ( P>0.05) . Conclusion: Intranasal dexmedetomidine ( DEX) ap-plication used in pediatric anesthesia induction period undergoing the lower abdomen and lower extremity sur-gery could significantly reduce induction time and have early postoperative analgesia sedation. For caudal block, which received the ropivacaine mixed with 1ug/kg dexmedetomidine can prolonge analgesia calm times and reduce adverse reaction during anesthesia recovery period .