切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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]. 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]. 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
[1]
李书林. 腹腔镜疝囊高位结扎术及无张力疝修补术治疗小儿腹股沟疝的效果观察[J]. 山西医药杂志, 2018, 47(16): 1952-1953.
[2]
Park SJ, Shin S, Kim SH, et al. Comparison of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for postoperative epidural analgesia in pediatric orthopedic surgery[J]. Yonsei Med J, 2017, 58(3): 650-657.
[3]
潘锋. 多模式镇痛是加速康复外科疼痛管理的发展趋势—访浙江大学医学院附属第二医院严世贵教授[J]. 中国当代医药, 2019, 26(12): 1-3.
[4]
Rove KO, Brockel MA, Saltzman AF, et al. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations[J]. J Pediatr Urol, 2018, 14(3): 252. e1-252. e9.
[5]
Gan TJ, Scott M, Thacker J, et al. American Society for Enhanced Recovery: advancing enhanced recovery and perioperative medicine[J]. Anesth Analg, 2018, 126(6): 1870-1873.
[6]
周晓筠，吴靦，朱毅, 等. 不同麻醉方法对小儿腹腔镜手术应激反应和复苏质量的影响[J]. 实用医学杂志, 2017, 33(13): 2186-2188.
[7]
Bagheri H, Govsa F. Anatomy of the sacral hiatus and its clinical relevance in caudal epidural block[J]. Surg Radiol Anat, 2017, 39(9): 943-951.
[8]
Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, et al. Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study[J]. J Clin Anesth, 2018, 44: 91-96.
[9]
Venkatraman R, Hungerford JL, Hall MW, et al. Dexmedetomidine for sedation during noninvasive ventilation in pediatric patients[J]. Pediatr Crit Care Med, 2017, 18(9): 831-837.
[10]
Goyal R, Mittal G, Yadav AK, et al. Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine[J]. Indian J Anaesth, 2017, 61(11): 903-909．
[11]
Trifa M, Tumin D, Tobias JD. Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children[J]. Minerva Anestesiol, 2018, 84(7): 836-847．
[12]
Im ST, Jo YY, Han G, et al. Dexmedetomidine inhibits voltage-gated sodium channels via α2 -adrenoceptors in trigeminal ganglion neurons[J]. Mediators Inflamm, 2018: 1782719.
[13]
Ni J, Wei JF, Yao YS, et al. Effect of dexmedetomidine on preventing postoperative agitation in children: A meta-analysis[J]. PLoS One, 2015, 10(5): e0128450.
[14]
Knight JB, Schott NJ, Kentor ML, et al. Neurotoxicity of common peripheral nerve block adjuvants[J]. Curr Opin Anaesthesiol, 2015, 28(5): 598-604.
[15]
Mohamed SA, El-Rahman AM, Fares KM. Intrathecal dexmedetomidine, ketamine, and their combination added to bupivacaine for postoperative analgesia in major abdominal cancer surgery[J]. Pain Physician, 2016, 19(6): E829-E839.
[16]
Lönnqvist PA, Ecoffey C, Bosenberg A, et al. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesiaand: what do they tell us?[J]. Curr Opin Anaesthesiol, 2017, 30(5): 613-620.
[17]
Shaikh SI, Mahesh SB. The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries[J]. J Anaesthesiol Clin Pharmacol, 2016, 32(2): 203-209．
[18]
Xu D, Xiu M, Zhang X, et al. Effect of dexmedetomidine added to ropivicaine for caudal anesthesia in patients undergoing hemorrhoidectomy: A prospective randomized controlled trial[J]. Medicine (Baltimore), 2018, 97(34): e11731．
[1] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[2] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[3] 韩丹, 王婷, 肖欢, 朱丽容, 陈镜宇, 唐毅. 超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 939-944.
[4] 刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 787-794.
[5] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[6] 米洁, 陈晨, 李佳玲, 裴海娜, 张恒博, 李飞, 李东杰. 儿童头面部外伤特点分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 511-515.
[7] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[8] 李芳, 许瑞, 李洋洋, 石秀全. 循证医学理念在儿童腹股沟疝患者中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 782-786.
[9] 彭永辉, 张文杰, 李炳根, 聂向阳, 吴凯, 杨六成. 单孔双针疝囊高位结扎术在儿童巨大腹股沟疝的临床应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 566-569.
[10] 吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[11] 卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[12] 黄泽辉, 梁杰贤, 曾伟. 右美托咪定联合艾司氯胺酮在小儿无痛胃镜检查中的应用研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 510-513.
[13] 刘笑笑, 张小杉, 刘群, 马岚, 段莎莎, 施依璐, 张敏洁, 王雅晳. 中国学龄前儿童先天性心脏病流行病学研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1021-1024.
[14] 李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
[15] 余林阳, 王美英, 李建斌, 楼骁斌, 谢思远, 马志忠, 齐海英, 李稼. 高原地区肺炎合并右心功能衰竭体征患儿的肺动脉压力和心脏形态与功能的特征[J]. 中华临床医师杂志(电子版), 2023, 17(05): 535-544.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号