经骶管单次注入布比卡因复合芬太尼用于婴幼儿腹部手术后镇痛的临床研究

发布时间：2018-10-22 08:06

【摘要】：目的：观察婴幼儿腹部手术后经骶管单次注入布比卡因复合芬太尼的镇痛效果，探讨该方法的安全性及实用性。方法：80例行择期腹部手术患儿，随机分为4组，每组20例。A组术毕经骶管注入0.1%布比卡因+芬太尼0.1μg/kg，B组术毕经骶管注入0.1%布比卡因，C组术毕经骶管注入芬太尼0.1μg/kg，D组骶管不注入任何药物，A、B、C组注药量为1.0ml/kg。记录各组患儿入室时(T0)、术毕时(T1)、气管拔管时(T2)、气管拔管后30min(T3)及术后2h(T4)、4h(T5)、8h(T6)、12h(T7)、24h(T8)、48h(T9)的收缩压（SBP）、舒张压（DBP）、呼吸频率（RR）、心率（HR）、脉搏血氧饱和度（SpO_2）。记录手术时间、麻醉时间及住院时间。用FLACC法进行镇痛评分并随访不良反应的发生例数。结果：患儿的性别、年龄、体重、手术种类、手术时间、麻醉时间及住院时间，四组间均无显著性差异（P＞0.05）。组间比较：患儿FLACC评分在T4时A、B、C组均低于D组，差异有统计学意义（P＜0.05）；在T5时A、B组低于C、D组，差异有统计学意义（P＜0.05）；在T6时A组低于B、C、D组，差异有统计学意义（P＜0.05）；T2、T3、T4、T5、T6、T7患儿HR A组慢于B、C、D组。组内比较：A组在T4、T5、T6时点患儿FLACC评分低于T2时点，差异有统计学意义（P＜0.05）；A组在T2时及T2后HR慢于T0，B、C、D组T2时及T2后HR快于T0，，差异有统计学意义（P＜0.05）。患儿SBP、DBP、RR、SpO_2各时间点各组差异无统计学意义（P＞0.05），均在正常范围之内。各组均有术后恶心呕吐、皮肤瘙痒等不良反应，但差异无统计学意义（P＞0.05），各组未发现尿潴留、运动阻滞及呼吸抑制，差异无统计学意义（P＞0.05）。结论： 1.经骶管单次注入布比卡因可为婴幼儿腹部手术后提供4小时左右满意的镇痛效果 2.布比卡因复合芬太尼用药可有效延长术后镇痛时间至8小时左右 3.婴幼儿腹部手术后单次将局麻药复合芬太尼注入骶管的方法安全有效。
[Abstract]:Objective: to observe the analgesic effect of bupivacaine combined with fentanyl once injected into sacral canal after abdominal operation in infants and to explore the safety and practicability of this method. Methods: 80 children undergoing elective abdominal surgery were randomly divided into 4 groups. In group A, 0.1% bupivacaine fentanyl 0.1 渭 g 路kg ~ (-1) was injected through sacral canal at the end of operation. In group C, 0.1% bupivacaine was injected through sacral canal at the end of operation, and no drug was injected into sacral canal in group D at the end of operation. Systolic pressure (SBP), diastolic pressure (DBP), (DBP), respiratory frequency (RR), (HR), pulse oxygen saturation (SpO_2) were recorded at the time of entry (T0), end of operation (T1), tracheal extubation (T2), 30min (T3) after tracheal extubation and 2h (T4), 4h (T5), 8h (T6), 12h (T7), 24h (T8), 48h (T9). Time of operation, duration of anesthesia and length of stay were recorded. FLACC method was used to score analgesia and follow up the incidence of adverse reactions. Results: there was no significant difference in sex, age, body weight, type of operation, operation time, anesthetic time and hospitalization time among the four groups (P > 0.05). Comparison between groups: the FLACC score of group A at T4 was lower than that of group D (P < 0. 05), and that of group B was lower than that of group C at T5 (P < 0. 05), and that of group A was lower than that of group D at T6 (P < 0. 05). Group HR A was slower than group D in group T _ 2, T _ 3, T _ 4, T _ 5, T _ 6 and T _ 7. Intragroup comparison: the FLACC score of group A was lower than that of T 2 at T 4, T 5 and T 6, and the difference was statistically significant (P < 0 05). The HR of group A was slower than that of T 2 and HR after T 2 in T 2 and T 2 group (P < 0 05). There was no significant difference in SBP,DBP,RR,SpO_2 in all groups (P > 0. 05), all of them were within normal range. Postoperative nausea and vomiting, pruritus and other adverse reactions were found in all groups, but the difference was not statistically significant (P > 0.05). There was no significant difference in urinary retention, motor block and respiratory inhibition in all groups (P > 0.05). Conclusion: 1. Single injection of bupivacaine through sacral canal can provide 4 hours of satisfactory analgesic effect for infants after abdominal operation. Bupivacaine combined with fentanyl can effectively prolong postoperative analgesia time to about 8 hours. It is safe and effective to inject local anesthetic and fentanyl into sacral canal after abdominal operation in infants.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.1

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