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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 198 -202. doi: 10.3877/cma.j.issn.1674-0793.2021.03.007

所属专题： 文献；

论著

右美托咪定复合罗哌卡因骶管阻滞在小儿腹腔镜疝囊高位结扎术中的临床效果
吴庆玲1,†(), 郑立东1, 李仁虎1   
  1. 1. 237005　安徽医科大学附属六安医院　六安市人民医院麻醉科
  • 收稿日期:2010-10-20 出版日期:2021-06-01
  • 通信作者: 吴庆玲

Clinical effect of dexmedetomidine combined with ultrasound-guided sacral canal block in laparoscopic high ligation of hernia sac in children

Qingling Wu1,†(), Lidong Zheng1, Renhu Li1   

  1. 1. Department of Anesthesiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an City People’s Hospital, Lu’an 237005, China
  • Received:2010-10-20 Published:2021-06-01
  • Corresponding author: Qingling Wu
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吴庆玲, 郑立东, 李仁虎. 右美托咪定复合罗哌卡因骶管阻滞在小儿腹腔镜疝囊高位结扎术中的临床效果[J/OL]. 中华普通外科学文献(电子版), 2021, 15(03): 198-202.

Qingling Wu, Lidong Zheng, Renhu Li. Clinical effect of dexmedetomidine combined with ultrasound-guided sacral canal block in laparoscopic high ligation of hernia sac in children[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(03): 198-202.

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。

关键词: 儿童, 右美托咪定, 超声学, 骶管阻滞
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.

Key words: Child, Dexmedetomidine, Ultrasonics, Sacral canal block
表1 90例腹腔镜小儿疝囊高位结扎术患儿围手术期相关情况（min，±s）
组别 例数 手术时间 苏醒时间 苏醒室观察时间 镇痛维持时间
常规组 45 32.4±9.2 4.1±0.8 25.7±3.9 221.6±44.2
联合组 45 31.9±8.6 3.9±0.9 25.1±4.0 302.7±50.1
t值   0.266 1.114 0.720 8.142
P值   0.395 0.134 0.236 0.000
表2 90例腹腔镜小儿疝囊高位结扎术患儿术中HR变化情况（次/min，±s）
组别 例数 T1 T2 T3 T4 T5 T6
常规组 45 104.5±11.2 96.7±9.2a 96.9±9.4a 97.1±10.0a 116.4±12.3 a 108.4±11.8
联合组 45 103.9±10.8 93.4±8.9a 91.8±9.0a 92.4±8.1a 105.9±11.1 104.7±10.8
t值   0.259 1.729 2.629 2.450 4.251 1.552
P值   0.797 0.087 0.010 0.016 0.000 0.124
表3 90例腹腔镜小儿疝囊高位结扎术患儿术中MAP变化情况（mmHg，±s）
组别 例数 T1 T2 T3 T4 T5 T6
常规组 45 71.4±7.0 69.1±7.8 70.2±8.1 70.6±7.7 74.4±9.8a 75.6±9.7a
联合组 45 71.2±7.4 68.9±8.2 68.1±7.4 68.3±7.3 70.4±8.9 71.7±8.4
t值   0.132 0.119 1.284 1.454 2.027 2.039
P值   0.896 0.906 0.203 0.150 0.046 0.045
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