儿童尿道下裂不同镇痛清洗方式对患儿疼痛及术后并发症的影响

摘要

目的 探讨尿道下裂患儿在不同镇痛方式下进行术前清洗对患儿疼痛及术后并发症的影响.方法 选取入院初次手术的3岁以上尿道下裂患儿105例,分为前期组与后期组两组,前期组患儿51例,术前1天阴茎表面麻醉下使用葡萄糖酸氯己定清理术野;后期组患儿54例,手术当天全麻下使用葡萄糖酸氯己定清理术野.记录清理完成率、清理时间、采用Wong-Baker面部表情量表法、生理反应PRST评分法记录患儿清理时疼痛强度.随访观察术后并发症发生情况,并进行统计学分析.结果 前期组清理完成率86.3％,后期组清理完成率100％,两组比较差异有统计学意义(P＜0.05);前期组清理时间长于后期组,两组比较差异有统计学意义(P＜0.005);前期组表面麻醉镇痛效果不理想,后期组全麻镇痛效果可靠,且节约时间、人力(P＜0.05).术后所有患儿均获随访,两组术后切口感染、漏尿、皮瓣缺血、尿道狭窄、尿道憩室并发症发生率比较,差异无统计学意义(P＞0.05).结论 手术当天全麻下清理术野具有操作完成率高、操作时间短、需要人手少、患儿无痛苦、家长无心理负担等优势,清理效果与术前1天清理效果相当,可在临床推广应用.%Objective To research the effects on pain and complications of different analgesic clean modes on children hypospadias.Methods 105 children with hypospadias above 3 years old was admitted to hospital for initial surgery.the earlier stage group (51 cases) underwent surface anesthesia and used chlorhexidine to clean the operation field one day before surgery.the later stage group (54 cases) underwent general anesthesia and used chlorhexidine to clean the operation field on the day of surgery.The cleanup completion rate and time,Wong-Banker facial scale (WBS) and PRST were recorded.The complications after operation were observed.Results The completion rate of the earlier stage group and later stage group were 86.3％,and 100％ (P＜0.05).The cleaning time in earlier stage group and later stage group were 7.4±2.6 min and 4.7±1.4 min (P＜0.005).The effect of surface anesthesia in the earlier stage group was not satisfactory.The effect of general anesthesia in the later stage group was reliable and only need one doctor and save time and work force.There was no significant difference in incisional infection,leakage of urine,flap ischemia,urethral stricture and urethral diverticulum complication between 2 groups (P＞ 0.05).Conclusion The general anesthesia on the day of surgery has the advantages of high degree of completion,save time work force,is without pain,and has no psychological burden.