摘要
目的:探讨不同麻醉方式对小儿包皮环切手术术中、术后麻醉镇痛效果及术后快速康复的影响。方法:从2018年1月至2019年3月在南通大学第二附属医院行包皮环切术的患儿共231例,排除疾病、药物过敏、不同意参加研究以及局部麻醉无法配合的患儿共141例,最终前瞻性纳入90例,随机分为3组,静脉麻醉联合罗哌卡因、利多卡因骶管阻滞组(I组)、静脉麻醉联合罗哌卡因骶管阻滞组(II组)、喉罩插管全身麻醉联合罗哌卡因骶管阻滞组(III组)。手术方法为传统切除缝合法。监测术中生命体征,记录从麻醉诱导到手术开始时间、运动阻滞评分、麻醉后监测治疗室(postanesthesia care unit, PACU)停留时间、记录术后各时点疼痛评分、术后镇痛给药次数、麻醉费用、住院时间等。结果:3组患儿均按术前制订的麻醉方案进行,麻醉效果满意,术中生命体征平稳。I,II,III组手术时间分别为(30.23±6.22) min,(29.24±5.91) min,(29.94±5.59) min。从麻醉诱导到手术开始时间3组差异无统计学意义(P=0.58)。I,II组术毕患儿送往PACU,III组术毕拔出喉罩后送往PACU。术中加用丙泊酚人数I,II组差异无统计学意义(P=0.573),III组术中七氟烷维持(1.0%~1.5%)。术后PACU停留时间(P=0.458)和住院时间(P=0.059)组间差异无统计学意义;术后使用镇痛药和术后疼痛评分差异无统计学意义(P>0.05),相对于II,III组,I组在术后30 min存在运动阻滞(P<0.001)。三组术后恶心呕吐的发生率差异无统计学意义(P=0.455),术后III组有7例(23.3%)患儿出现苏醒期躁动、3例(10%)患儿出现分泌物增多。III组的麻醉费用比I,II两组高出近1倍。结论:静脉麻醉复合罗哌卡因骶管阻滞用于小儿包皮环切术麻醉和术后镇痛效果佳,不良反应少,麻醉费用低,加速患儿的术后康复。
Objective:To explore the effects of different anesthesia methods on intraoperative and postoperative analgesia and enhanced recovery after surgery in pediatric circumcision.Methods:From January 2018 to March 2019,a total of 231 children underwent circumcision in our hospital.A total of 141 children who were with certain disease,drug allergies,did not agree to participate in the study,and could not cooperate with local anesthesia were excluded in this study.Finally,90 children undergoing circumcision in our hospital were prospectively enrolled.They were randomly divided into three groups:the intravenous anesthesia combined with ropivacaine and lidocaine sacral anesthesia group(group I),the intravenous anesthesia combined with ropivacaine sacral anesthesia group(group II),and the laryngeal mask anesthesia combined with ropivacaine sacral anesthesia group(group III).The surgical method was traditional resection and suture.The vital signs were monitored,the time from induction of anesthesia to the beginning of operation was recorded,the total times of analgesia postoperatively was calculated,and the pain score,motor block score,post-anesthesia care unit(PACU)stay,anesthesia cost and hospital stay were recorded.Results:The effect of anesthesia was satisfactory in all three groups,and the anesthesia method was not changed during the operation.The average operation time in group I,II and III was(30.23±6.22)min,(29.24±5.91)min,(29.94±5.59)min.There was no significant difference in the time from induction of anesthesia to the beginning of operation between the three groups(P=0.58).Children in groups I and II were sent to PACU after operation,while those in group III were sent to PACU after removal of laryngeal mask.There was no difference in propofol consumed during operation between group I and group II(P=0.573).Sevoflurane was maintained 1.0%–1.5%in group III.There was no difference between the postoperative PACU stay time(P=0.458)and hospital stay time(P=0.059).Compared with group II and III,group I had motor block at 30min after operation(P<0.001).No difference was found in postoperative nausea and vomiting between the three groups(P=0.455).There were seven patients(23.3%)with delirium,and 3(10%)with increased excretions in group III.The cost of anesthesia in group III was nearly twice over those in group I and group II.Conclusion:Intravenous anesthesia combined with ropivacaine fistula block for pediatric circumcision can provide satisfactory anesthesia and postoperative analgesia,reduce complications and anesthesia cost,and promote the postoperative recovery of children.
作者
沈晓平
宋杰
SHEN Xiaoping;SONG Jie(Department of Anesthesiology,Second Affiliated Hospital of Nantong University,Nantong Jiangsu 226000,China)
出处
《临床与病理杂志》
2021年第1期67-73,共7页
Journal of Clinical and Pathological Research
关键词
骶管阻滞
罗哌卡因
包皮环切术
镇痛
加速康复外科
analgesia
caudal block
circumcision
enhanced recovery after surgery
ropivacaine
