摘要
目的 探讨地佐辛不同给药方式联合右美托咪定滴鼻在小儿腹腔镜疝修补术中的效果。方法 选取2020年1月-2020年6月昆明市儿童医院行腹腔镜疝修补术患儿90例,随机分为三组:地佐辛静脉注射组(A组)、地佐辛静脉泵注组(B组)和空白对照组(C组)。三组患儿术前均予2μg/kg右美托咪定滴鼻,入室后进行全麻气管插管。A组患儿手术开始时静脉注射地佐辛1 ml/kg(地佐辛稀释至0.1 mg/ml),并静脉泵注1 ml/kg生理盐水15 min泵完;B组患儿手术开始时静脉注射生理盐水1 ml/kg,并静脉泵注1 ml/kg地佐辛15 min泵完;C组患儿手术开始时静脉注射生理盐水1 ml/kg,并静脉泵注1 ml/kg生理盐水15 min泵完。术中七氟醚维持,术毕带管送入PACU,均不使用术后镇痛泵。记录患儿麻醉诱导前(T0)、手术开始时(T1)、建立气腹后(T2)、气腹后5 min(T3)、术毕(T4)、拔管时(T5)、出手术室时(T6)、入病房60 min (T7)、入病房120 min(T8)的平均动脉压及心率,烦躁(PAED)、镇痛(VAS)、镇静(Ramsay)评分、手术时间、术毕拔管时间、术毕至出手术室时间及术后消化道不良反应发生情况。结果 A组T3时平均动脉压和心率低于B组和C组(P<0.05);A组与B组T5、T6、T7时平均动脉压和心率低于C组(P<0.05)。A组与B组T5、T8时PAED评分低于C组(P<0.05);A组和C组T6、T7时PAED评分高于B组(P<0.05)。A组与B组T5、T6、T7、T8时VAS评分低于C组(P<0.05);B组T6时VAS评分低于A组(P<0.05)。A组与B组T5、T6、T7时Ramsay评分高于C组(P<0.05)。三组手术时间、术毕至出手术室时间比较,差异无统计学意义(P>0.05);A组与B组术毕拔管时间长于C组(P<0.05)。B组与C组消化道不良事件发生率低于A组(P<0.05)。结论 静脉泵注地佐辛联合右美托咪定滴鼻在小儿腹腔镜疝修补术中可使患儿循环更稳定,有效缓解术后患儿的疼痛程度,改善术后躁动,且消化道不良反应发生率更低。
Objective To investigate the effect of dezocine administration combined with intranasal administration of dexmedetomidine in laparoscopic hernia repair in children.Methods Ninety children with laparoscopic hernia repair in Kunming Children’s Hospital from January 2020 to June 2020were selected. They were randomly divided into three groups: dezocine intravenous injection group(group A), dezocine intravenous pumping group(group B) and blank control group(group C). All patients in the three groups were given dexmedetomidine nasal drops 2 μg/kg before surgery, and tracheal intubation under general anesthesia after entering the room. In group A, 1 ml/kg desocine was intravenously injected at the beginning of surgery(desocine diluted to 0.1 mg/ml), and 1 ml/kg normal saline was intravenously pumped for 15 minutes. In group B, normal saline was injected intravenously at the beginning of surgery, and dexocine was injected intravenously at 1 ml/kg for 15 minutes. In group C, 1 ml/kg normal saline was injected intravenously at the beginning of surgery, and 1 ml/kg normal saline was pumped intravenously for 15 minutes. Sevoflurane was maintained during the operation, and PACU was delivered with a tube after the operation without postoperative analgesic pump. Before anesthesia induction(T0),at the beginning of surgery(T1), after pneumoperitoneum establishment(T2), 5min after pneumoperitoneum establishment(T3), at the end of surgery(T4), at extubation(T5), at departure from the operating room(T6), 60 min after admission to the ward(T7), and 120 min after admission to the ward(T8), the mean arterial pressure, heart rate, the scores of dysphoria(PAED), analgesia(VAS) and sedation(Ramsay),the operative time, the time of biextubation, the time from the operation to the operation room, and the incidence of postoperative gastrointestinal adverse reactions in the three groups were recorded.Results Mean arterial pressure and heart rate at T3 in group A were lower than those in group B and C(P<0.05), mean arterial pressure and heart rate at T5, T6 and T7 in group A and group B were lower than those in group C(P<0.05). The PAED scores at T5 and T8 in group A and group B were lower than those in group C(P<0.05), the PAED scores at T6 and T7 in group A and group C were higher than those in group B(P<0.05). The VAS scores at T5, T6, T7 and T8 in group A and group B were lower than those in group C(P<0.05), the VAS score at T6 in group B was lower than that in group A(P<0.05), Ramsay scores at T5, T6 and T7 in group A and group B were higher than those in group C(P<0.05). There was no significant difference in the operation time and the time from the end of operation to the operation room among the three groups( P>0.05). The extubation time of group A and group B was longer than that of group C(P<0.05). The incidence of gastrointestinal adverse events in group B and group C was lower than that in group A(P <0.05).Conclusion Intravenous infusion of dezocine combined with dexmedetomidine nasal drip in pediatric laparoscopic hernia repair can make the circulation more stable, effectively relieve postoperative pain, improve postoperative agitation, and with lower incidence of gastrointestinal adverse reactions.
作者
张玉龙
廖顺芬
林丽佳
杜文康
ZHANG Yu-long;LIAO Shun-fen;LIN Li-jia;DU Wen-kang(Department of Anesthesioloey,Kunming Children's Hospital,Kunming 650000,Yunnan,China;Infection Management Office,the Third People's Hospital of Kunming,Kunming 650041,Yunnan,China)
出处
《医学信息》
2022年第21期54-57,61,共5页
Journal of Medical Information
基金
昆明市卫生科技人才培养项目暨“十百千”工程培养计划[编号:2020-SW(后备)-110]。
关键词
地佐辛
腹股沟疝修补术
右美托咪定
小儿疝气
Dezocine
Inguinal hernia repair
Dexmedetomidine
Children with hernia
