摘要
目的研究右美托咪定联合超声引导骶管阻滞在小儿腹腔镜疝囊高位结扎术中的临床效果。方法前瞻性纳入2018年1月至2019年12月在六安市人民医院行腹腔镜下小儿疝囊高位结扎术患儿90例。随机数字法将所有患儿分为两组,常规组使用罗哌卡因进行骶管阻滞麻醉,联合组行右美托咪定+罗哌卡因骶管阻滞麻醉。比较两组患儿手术相关情况,包括手术时间、苏醒时间、苏醒室观察时间及镇痛持续时间。比较两组患儿麻醉前(T1)、完成骶管阻滞后(T2)、切皮时(T3)、手术完成时(T4)、拔除气管导管时(T5)、苏醒后10 min(T6)时的心率(HR)、平均动脉压(MAP),及在苏醒期躁动的发生率、躁动评分。结果两组患儿手术时间、苏醒时间及苏醒室观察时间差异无统计学意义,镇痛维持时间常规组短于联合组(P<0.05)。T1时两组患儿HR、MAP差异无统计学意义;T3~T5时联合组HR明显低于常规组(P<0.05);T5~T6时联合组MAP水平低于常规组(P<0.05)。常规组患儿苏醒期躁动发生率为22.2%,明显高于联合组的6.7%(P<0.05);联合组患儿躁动评分明显低于常规组(P<0.05)。结论右美托咪定联合超声引导骶管阻滞在小儿腹腔镜疝囊高位结扎术中可降低术中患儿机体应激反应,保持血流动力学稳定,有效减少术后苏醒期躁动的发生,提高苏醒期质量。
Objective To investigate the clinical effect of dexmedetomidine combined with ultrasound-guided sacral canal block in the high ligation of laparoscopic hernia sac in children.Methods 90 cases of children undergoing laparoscopic high ligation of hernia sac in Lu’an People’s Hospital from January 2018 to December 2019 were prospectively included.All the children were divided into two groups by random number method.The conventional group received sacral block anesthesia with ropivacaine,and the combination group received sacral block anesthesia with dexmedetomidine plus ropivacaine.The operative time,recovery time、observation time in the resuscitation room and maintenance time of analgesia were compared between the two groups.Hemodynamics,including heart rate and mean arterial pressure,were compared between the two groups at pre-anesthesia(T1),post-sacral block(T2),dermectomy(T3),surgical completion(T4),tracheal catheter removal(T5),and 10 minutes after resuscitation(T6).The agitation of the two groups during the waking period was compared,including the incidence of agitation and the agitation score.Results There were no significant differences in operation time,recovery time and observation time in recovery room between the two groups.The analgesia maintenance time in the conventional group was significantly shorter than that of the combination group(P<0.05).There were no significant differences in HR and MAP between the two groups at T1.HR of the combination group was significantly lower than that of the conventional group from T3 to T5(P<0.05).MAP level in the combination group was lower than that of the conventional group at T5-T6(P<0.05).The incidence of restlessness in the conventional group was 22.2%,which was significantly higher than that of the combination group(6.7%)(P<0.05).The agitation score of the combination group was significantly lower than that of the conventional group(P<0.05).Conclusion The application of dexmedetomidine combined with ultrasound guided anesthesia in the high ligation of laparoscopic hernia sac in children can reduce the stress response of the body during the operation,maintain a more stable hemodynamic state,effectively reduce the occurrence of postoperative agitation during the recovery period,and improve the quality of the recovery period.
作者
吴庆玲
郑立东
李仁虎
Wu Qingling;Zheng Lidong;Li Renhu(Department of Anesthesiology,Lu’an Hospital Affiliated to Anhui Medical University,Lu’an City People’s Hospital,Lu’an 237005,China)
出处
《中华普通外科学文献（电子版）》
CAS
2021年第3期198-202,共5页
Chinese Archives of General Surgery(Electronic Edition)
关键词
儿童
右美托咪定
超声学
骶管阻滞
Child
Dexmedetomidine
Ultrasonics
Sacral canal block
