右美托咪定复合罗哌卡因臂丛神经阻滞用于小儿围术期镇痛管理的评价

发布时间：2018-04-03 09:08

  本文选题：右美托咪定　切入点：罗哌卡因　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:临床上小儿手外伤手术常用的局部麻醉方法为臂丛神经阻滞,以往常采用利多卡因,但患儿麻醉持续时间较短,不利于患儿围手术期镇痛管理,为此,为了延长手外伤患儿的镇痛时间,保证镇痛效果,采用右美托咪定复合罗哌卡因臂丛神经腋路给药方法。本次研究比较罗哌卡因和右美托咪定复合罗哌卡因臂丛神经阻滞用于小儿围术期镇痛管理。方法:选择30例手外伤患儿,年龄2-6岁,体重7-25公斤,ASAI或II级,术前4周未见呼吸道感染,无手术禁忌。采用随机数字表法,随机分为罗哌卡因组(L组)和右美托咪定复合罗哌卡因组(D组),每组15例。患儿面罩吸入8%七氟醚,吸入麻醉成功后插入喉罩,保留自主呼吸,七氟醚调整为3%。静脉予以抗胆碱药阿托品0.15mg/kg,糖皮质激素地塞米松0.2mg/kg。后行B超定位神经刺激仪引导下腋路臂丛神经阻滞。罗哌卡因组手外伤患儿臂丛神经腋路注入0.25%罗哌卡因1ml/kg,右美托咪定复合罗哌卡因组手外伤患儿予以0.25%罗哌卡因1ml/kg复合右美托咪定1μg/kg。手术中,持续吸入2%七氟醚。手术后停用七氟醚。术后记录两组患儿臂丛神经阻滞起效时间、臂丛神经镇痛持续时间、术后躁动发生率等不良反应发生情况。结果:罗哌卡因组和右美托咪定复合罗哌卡因组患儿年龄、体重、性别构成、手术时间比较差异并无统计学意义(P0.05);罗哌卡因组的臂丛神经阻滞起效时间为(13.0±3.5)min,右美托咪定复合罗哌卡因组的臂丛神经阻滞起效时间为(10.4±2.3)min(P0.05);罗哌卡因组的苏醒时间为(13.1±8.7)min,右美托咪定复合罗哌卡因组的苏醒时间为(13.5±2.4)min(P0.05);右美托咪定复合罗哌卡因组的持续镇痛时间为(654.0±31.9)min,罗哌卡因组的镇痛时间为(545.0±21.5)min,右美托咪定复合罗哌卡因组的持续镇痛时间明显大于罗哌卡因组(P0.05);罗哌卡因组和右美托咪定复合罗哌卡因组患儿FLACC分值比较具有显著意义(P0.05);罗哌卡因组的术后躁动发生率为53.33%,右美托咪定复合罗哌卡因组的术后躁动发生率为20.00%(P0.05).罗哌卡因组不良反应发生率为20%,右美托咪定复合罗哌卡因组不良反应发生率为6.67%(P0.05)。结论:与单纯使用罗哌卡因麻醉相比,采用右美托咪定复合罗哌卡因臂丛神经阻滞能够缩短臂丛神经起效时间,延长镇痛持续时间,不影响苏醒时间。右美托咪定复合罗哌卡因组FLACC评分分值减少,镇痛效果更明显。同时,不增加不良反应,用于手外伤患儿围手术期镇痛安全性、有效性较高,有利于患儿的术后恢复。
[Abstract]:Objective: the common local anesthetic method in pediatric hand trauma surgery is brachial plexus block, which is usually treated with lidocaine, but the duration of anesthesia in children is shorter, which is not conducive to the perioperative analgesia management of children.In order to prolong the analgesic time and ensure the analgesic effect, dexmetomidine combined with ropivacaine in brachial plexus was used.In this study, ropivacaine and dexmetomidine combined with ropivacaine were compared for perioperative analgesia management in children.Methods: 30 children with hand trauma, aged 2-6 years, weighing 7-25 kg ASAI or II, had no respiratory tract infection at 4 weeks before operation and had no contraindication.The patients were randomly divided into ropivacaine group (n = 15) and dexmetomidine combined with ropivacaine group (n = 15).The mask inhaled 8% sevoflurane, inserted the laryngeal mask after anesthesia, and kept breathing autonomously. Sevoflurane was adjusted to 3.Atropine 0.15 mg / kg, glucocorticoid dexamethasone 0.2 mg / kg.The nerve block of axillary brachial plexus guided by B-ultrasound localizing nerve stimulator was performed.In the ropivacaine group, 0.25% ropivacaine 1 ml / kg was injected into the brachial plexus nerve of the children with hand trauma. The patients in the dexmetomidine combined with ropivacaine group were given 0.25% ropivacaine 1ml/kg combined with dexmetoimidine 1 渭 g / kg.During the operation, 2% sevoflurane was inhaled continuously.Sevoflurane was discontinued after operation.The onset time of brachial plexus block, the duration of brachial plexus analgesia and the incidence of postoperative restlessness were recorded.Results: the age, body weight and sex composition of ropivacaine group and dexmetomidine combined ropivacaine group,The time of brachial plexus block was 13.0 卤3.5 min in ropivacaine group, 10.4 卤2.3 min in ropivacaine group and 10.4 卤2.3 min in ropivacaine group.(13.1卤8.7)min,鍙崇編鎵樺挭瀹氬�嶅悎缃楀搶鍗″洜缁勭殑鑻忛啋鏃堕棿涓�(13.5卤2.4)min(P0.05);鍙崇編鎵樺挭瀹氬�嶅悎缃楀搶鍗″洜缁勭殑鎸佺画闀囩棝鏃堕棿涓�(654.0卤31.9)min,缃楀搶鍗″洜缁勭殑闀囩棝鏃堕棿涓，

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