多模式镇痛在腭裂手术婴幼儿的应用
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摘要
目的观察多模式镇痛应用于婴幼儿腭裂修补术围手术期镇痛的效果。方法腭裂修补术婴幼儿63例,采用七氟烷吸入联合丙泊酚泵注全身麻醉,术中实施2%利多卡因2 ml腭前神经阻滞。随机分为两组:M组32例,气管插管后应用对乙酰氨基酚10 mg/kg塞肛,术毕纳布啡0.2 mg/kg静脉注射;B组31例,手术结束前15 min静脉注射芬太尼1μg/kg。评估患儿术后6 h内的Riker和FLACC评分,记录术后需要再插管或因为再出血而需非计划手术止血的病例数以及术后第一次饮水成功的时间。结果术后6 h内,M组的Riker评分(2.78±0.81)分,少于B组的(5.82±1.03)分(P<0.05);M组的FLACC评分为(2.08±1.12)分,少于B组的(6.57±2.34)分(P<0.05)。M组患儿术后再插管和因为出血需要手术止血的比例少于B组(0 vs.12.9%和6.3%vs.41.9%)(P<0.05);M组患儿术后第一次成功饮水时间为(3.94±1.32) h,早于B组的(7.13±2.73) h(P<0.05)。结论多模式镇痛方案用于婴幼儿腭裂术后镇痛安全有效。
Objective To observe the efficacy of multimodal analgesia in the infants and young children undergoing palatorrhaphy.Methods Palatorrhaphy was performed in 63 infants and young children under endotracheal intubation general anesthesia with sevoflurane inhalation combined with propofol infusion.Anterior palatal nerve block with 2%lidocaine 2 ml was performed before surgery.The patients were randomly assigned into two groups.The multimodal analgesia in group M(32 cases)was conducted with paracetamol 10 mg/kg anal plug after endotracheal intubation and naborphine 0.2 mg/kg intravenously at the end of operation,which in group B(31 cases)was conducted with fentanyl 1μg/kg intravenously at 15 minutes before the end of surgery.Riker and FLACC scores were evaluated within 6 hours postoperatively.The numbers of cases needed for re-intubation and surgical hemostasis because of re-bleeding and the time of first successfully drinking after operation were recorded.Results Within 6 hours postoperatively,Riker score[(2.78±0.81)points vs.(5.82±1.03)points]and FLACC score[((2.08±1.12)points vs.(6.57±2.34)points]were lower in group M than those in group B(P<0.05).The percentages of cases needed for re-intubation(0 vs.12.9%)and surgical hemostasis because of re-bleeding(6.3% vs.41.9%)were less in group M than those in group B(P<0.05).The time of first successfully drinking after operation was earlier in group M than that in group B[(3.94±1.32)hours vs.(7.13±2.73)hours](P<0.05).Conclusion The multimodal analgesia is effective and safe in the infants and young children undergoing palatorrhaphy.
Objective To observe the efficacy of multimodal analgesia in the infants and young children undergoing palatorrhaphy.Methods Palatorrhaphy was performed in 63 infants and young children under endotracheal intubation general anesthesia with sevoflurane inhalation combined with propofol infusion.Anterior palatal nerve block with 2%lidocaine 2 ml was performed before surgery.The patients were randomly assigned into two groups.The multimodal analgesia in group M(32 cases)was conducted with paracetamol 10 mg/kg anal plug after endotracheal intubation and naborphine 0.2 mg/kg intravenously at the end of operation,which in group B(31 cases)was conducted with fentanyl 1μg/kg intravenously at 15 minutes before the end of surgery.Riker and FLACC scores were evaluated within 6 hours postoperatively.The numbers of cases needed for re-intubation and surgical hemostasis because of re-bleeding and the time of first successfully drinking after operation were recorded.Results Within 6 hours postoperatively,Riker score[(2.78±0.81)points vs.(5.82±1.03)points]and FLACC score[((2.08±1.12)points vs.(6.57±2.34)points]were lower in group M than those in group B(P<0.05).The percentages of cases needed for re-intubation(0 vs.12.9%)and surgical hemostasis because of re-bleeding(6.3% vs.41.9%)were less in group M than those in group B(P<0.05).The time of first successfully drinking after operation was earlier in group M than that in group B[(3.94±1.32)hours vs.(7.13±2.73)hours](P<0.05).Conclusion The multimodal analgesia is effective and safe in the infants and young children undergoing palatorrhaphy.
引文
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[2] 吴庆忠.小儿腭裂修补术全麻中辅以腭前神经阻滞的临床观察[J].江西医学院院报,2001,41(6):79-80.
[3] 王建光.小儿疼痛的评估[J].实用儿科学杂志,2006,21(11):711-712.
[4] 刘莹.不同年龄阶段儿童疼痛评估工具的选择[J].中国疼痛医学杂志,2012,18(12):752-755.
[5] Nour C, Ratsiu J, Singh N,et al.Analgesic effectiveness of acetaminophen for primary cleft palate repair in young children:a randomized placebo controlled trial[J]. Paediatr Anaesth,2014,24(6):574-581.
[6] Jha AK, Bhardwaj N, Yaddanapudi S,et al.A randomized study of surgical site infiltration with bupivacaine or ketamine for pain relief in children following cleft palate repair[J]. Paediatr Anaesth,2013,23(5):401-406.
[7] Bressolle F,Khier S,Rochette A,et al.Population pharmacokinetics of nalbuphine after surgery in children[J]. Br J Anaesth,2011,106(4):558-565.
[8] Kubica-Cielińska A, Zielińska M. The use of nalbuphine in paediatric anaesthesia[J].Anaesthesiol Intensive Ther,2015,47(3):252-256.
[9] Chiaretti A, Pierri F, Valentini P,et al.Current practice and recent advances in pediatric pain management[J]. Eur Rev Med Pharmacol Sci,2013,17(Suppl 1):112-126.
[10] Palmer GM. Pain management in the acute care setting:update and debates[J].J Paediatr Child Health,2016,52(2):213-220.
[11] Schnabel A, Reichl SU, Zahn PK, et al. Nalbuphine for postoperative pain treatment in children[J].Cochrane Database Syst Rev,2014(7):CD009583.