多模式镇痛对学龄前儿童腹腔镜下疝修补术后的镇痛效果观察
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摘要
目的:观察多模式镇痛对学龄前儿童腹腔镜下疝修补术后的镇痛效果。方法:选择全身麻醉下择期行腹腔镜下疝修补术的患儿90例,随机均分三组:多模式镇痛组(A组),局麻组(B组),舒芬太尼组(C组),每组各30例。三组均采用吸入全麻(七氟醚+罗库溴铵)。A组在术前静注帕瑞昔布钠0.8mg/kg,手术结束前10min静推舒芬太尼0.2μg/kg,在缝合切口时用0.25%罗哌卡因局部逐层浸润麻醉手术切口;B组只在缝合切口时用0.25%罗哌卡因局部逐层浸润麻醉手术切口;C组在手术结束前10min静注舒芬太尼0.2μg/kg。分别于患儿清醒拔管后即刻(T1)、术后1h(T2)、2h(T3)、4h(T4)、8h(T5)和12h(T6)采用改良面部表情评分法观察镇痛效果,观察患儿呼吸抑制、恶心、呕吐、头晕、瘙痒等不良反应的发生情况。结果:在T1时间点比较三组患者面部表情评分及FLACC评分差异无统计学意义(P>0.05);T2、T3、T4时点A组、B组面部表情评分和FLACC评分低于C组,差异具有统计学意义(P<0.05);T5、T6两时点三组间的面部表情评分和FLACC评分差异具有统计学意义(P<0.05);三组患儿间不良反应差异无统计学意义(P>0.05)。结论:小剂量的舒芬太尼联合长效非甾体类抗炎镇痛药和手术切口局麻药浸润用于学龄前儿童腹腔镜下疝修补术后镇痛效果优于局麻组(B组)和舒芬太尼组(C组),值得临床推广。
引文
[1]罗国占,陈明胡,曾伟,等.不同剂量舒芬太尼复合曲马多用于烧伤患儿术后镇痛的比较[J].临床麻醉学杂志,2014,30:758-761
[2]王建光,李雪梅,连庆泉.小儿术后镇痛进展[J].实用儿科杂志,2005,20:478-480
[3]王春光,韦应晖,韦雄丽,等.右美托咪定复合罗哌卡因骶管阻滞用于小儿疝囊高位结扎术围术期镇痛效果评估[J].中国药业,2018(10):60-62
[4] Kortesluoma RL,Nikkonen M,Serlo W.“you just have to make the pain go away”:children's experiences of pain managearent[J].Pain Manag Nurs,2008,9(4):143-149
[5] Gehling M,Arndt C,Eberhart LH,et al.Postoperative analgesia with parecoxib,acetaminophen,and the combination of both:a randomized,double-blind,placebo controlled trial in patients undergoing thyroid surgery[J].Br J Anaesth,2010,104:761-767
[6]崔向丽,赵志刚,陈丽,等.新型注射用选择性COX-2抑制剂帕瑞昔布钠[J].中国新药杂志,2009(18):1283-1286
[7] Bourgeade F,Payen M,Daigremon C,et al.Respiratory dpression after an accidental large dose of intrathecal sufentanil[J].Ann Fr Anesth Rreanim,2009,28,(10):903-904
[8] Lundeberg S,Roelofse JA.Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice[J].Paediatr Anaesth,2011,21(3):274-279
[9]陈煜,连庆泉.当代小儿麻醉学[M].北京:人民卫生出版社,2011:479-489,704
[10] Tina HD,Ebba HH.A qualitative systematic review of morphine treatment in children with postoperative pain[J].Paediatr Anesth,2007,17(4):756-774
[2]王建光,李雪梅,连庆泉.小儿术后镇痛进展[J].实用儿科杂志,2005,20:478-480
[3]王春光,韦应晖,韦雄丽,等.右美托咪定复合罗哌卡因骶管阻滞用于小儿疝囊高位结扎术围术期镇痛效果评估[J].中国药业,2018(10):60-62
[4] Kortesluoma RL,Nikkonen M,Serlo W.“you just have to make the pain go away”:children's experiences of pain managearent[J].Pain Manag Nurs,2008,9(4):143-149
[5] Gehling M,Arndt C,Eberhart LH,et al.Postoperative analgesia with parecoxib,acetaminophen,and the combination of both:a randomized,double-blind,placebo controlled trial in patients undergoing thyroid surgery[J].Br J Anaesth,2010,104:761-767
[6]崔向丽,赵志刚,陈丽,等.新型注射用选择性COX-2抑制剂帕瑞昔布钠[J].中国新药杂志,2009(18):1283-1286
[7] Bourgeade F,Payen M,Daigremon C,et al.Respiratory dpression after an accidental large dose of intrathecal sufentanil[J].Ann Fr Anesth Rreanim,2009,28,(10):903-904
[8] Lundeberg S,Roelofse JA.Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice[J].Paediatr Anaesth,2011,21(3):274-279
[9]陈煜,连庆泉.当代小儿麻醉学[M].北京:人民卫生出版社,2011:479-489,704
[10] Tina HD,Ebba HH.A qualitative systematic review of morphine treatment in children with postoperative pain[J].Paediatr Anesth,2007,17(4):756-774