多模式镇痛在患儿先天性髋关节脱位矫正术快速康复中的应用

发布时间：2018-10-18 13:41

【摘要】：目的观察基于快速康复外科理念的多模式镇痛在患儿先天性髋关节脱位手术治疗中的应用。方法择期行髋关节脱位手术患儿90例,年龄1~7岁,随机分为三组,每组30例。A组采用静-吸复合全麻;B组采用静-吸复合全麻复合骶管阻滞,即麻醉诱导后骶管注射0.25%罗哌卡因1ml/kg;C组在B组的基础上于手术前15min肛塞对乙酰氨基酚30~35mg/kg。三组患儿术后均采用舒芬太尼静脉自控镇痛(PCIA)。分别记录患儿术后苏醒即刻(T1)、4h(T2)、8h(T3)、12h(T4)、24h(T5)、36h(T6)、48h(T7)的FLACC疼痛评分和Ramsay镇静评分,以及苏醒即刻PAED躁动评分。结果与A组比较,B组和C组T1~T6时FLACC评分明显降低,T1、T2时Ramsay评分明显升高,T1时PAED评分明显降低(P0.05);T7时C组FLACC评分明显降低(P0.05)。与B组比较,T4、T5、T7时C组FLACC评分明显降低(P0.05)。结论骶管阻滞、肛塞对乙酰氨基酚联合PCIA用于患儿先天性髋关节脱位矫正术可增强术后镇痛效果,减少苏醒期躁动的发生,利于快速康复。
[Abstract]:Objective to observe the application of multi-mode analgesia based on rapid rehabilitation surgery in the surgical treatment of congenital dislocation of hip in children. Methods 90 children with hip dislocation, aged 1 to 7 years, were randomly divided into three groups, 30 cases in each group. That is, after anesthesia induction, 0.25% ropivacaine was injected into the sacral canal of group C on the basis of group B, and paracetamol 30 mg / kg / kg of acetaminophen was inserted into the anus of group B before operation. Sufentanil for patient-controlled analgesia (PCIA).) was used in all three groups after operation. FLACC pain scores and Ramsay sedation scores were recorded immediately after recovery (T1), 4h (T2), 8h (T3), 12h (T4), 24h (T5), 36h (T6), 48h (T7), and PAED restlessness. Results compared with group A, FLACC score of group B and group C decreased significantly at T1~T6, Ramsay score of group T _ 1 and T _ 2 increased significantly, PAED score of group T _ 1 decreased significantly (P 0.05), FLACC score of group C decreased significantly at group T _ 7 (P0.05). Compared with group B, the FLACC score of group C was significantly lower than that of group B (P 0.05). Conclusion sacral canal block, anus paracetamol combined with PCIA can enhance postoperative analgesia, reduce restlessness during recovery, and facilitate rapid recovery in children with congenital dislocation of hip.
【作者单位】：安徽医科大学第一附属医院麻醉科;安徽省儿童医院麻醉科;
【分类号】：R726.1

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