盐酸右美托咪啶联合舒芬太尼在小儿肛门直肠畸形术后镇痛镇静的应用

摘要

目的 观察盐酸右美托咪啶联合舒芬太尼用于小儿肛门直肠畸形矫正术后镇痛镇静的效果.方法 以2012年11月至2014年8月于本院行择期肛门直肠畸形矫正术的60例患儿为研究对象,均行骶管麻醉,麻醉维持期予瑞芬太尼及丙泊酚,随机将其分为观察组及对照组(每组各30例),术毕观察组静脉自控镇痛予舒芬太尼、右美托咪啶及托烷司琼,对照组予舒芬太尼及托烷司琼.观察术后30 min、1h、2h、4h、12h及24 h各时点两组患儿脸谱疼痛评分(faces pain scale,FPS)及Ramsay镇静评分,并分别记录舒芬太尼、瑞芬太尼、丙泊酚用量及不良反应发生情况.结果 两组术后30 min、1 h、2h、4h、24 h的FPS评比较,差异均无统计学意义(P＞0.05),术后12 h观察组FPS评分显著低于对照组(P＜0.05).术后两组各时点Ramsay镇静评分均低于4分,未见过度镇静病例,观察组2h及4h的Ramsay镇静评分显著高于对照组(P＜0.05),其他时点两组比较,差异均无统计学意义(P＞0.05).观察组无不良反应病例,两组恶心、呕吐、心动过缓发生率差异均无统计学意义(P＞0.05).结论 盐酸右美托咪啶联合舒芬太尼用于小儿肛门直肠畸形矫正术骶管麻醉术后可获得较理想的镇痛镇静效果,并可减少不良反应的发生.%Objective To study the effects of dexmedetomidine hydrochloride combined with sufentanil as post-operation analgesia in pediatric anorectal malformation.Methods 60 cases of children who underwent elective operation for correction of anorectal malformation in our hospital were randomized into the treatment group (dexmedetomidine combined with sufentanil) and the control group (sufentanil),with 30 cases in each group.All children underwcnt sacral anesthesia.The control group received intravenous controlled analgesia with sufentanil of 0.04 μg/kg/h and 5 mg tropisetron in 100 mL of normal saline.The treatment group received sufentanil of 0.03 μg/kg/h,dexmedetomidine of 0.04 μg/kg/h and 5 mg of tropisetron in 100 mL of normal saline 0.5.The following parameters were recorded:FPS scores and Ramsay sedation scores at l,2,4,12 and 24 h after operation,the total dosage of sufentanil and remifentanil,and the incidence of adverse reactions.Results There was no significant difference in FPS score between the two groups at 0.5,1,2,4 and 24h after operation (P ＞ 0.05).12 hours after operation,the FPS score of the treatment group was significantly lower than that of the control group (P ＜ 0.05).There were significant differences in Ramsay sedation score between the two groups at 2 and 4h after operation (P ＜ 0.05),but the differences at other time points were not statistically significant (P ＞0.05).All scores of the two groups were less than 4,and there was no excessive sedation.There were no adverse reactions in the treatment group.The incidence rates of nausea,vomiting and bradycardia between the two groups were without significance (P ＞ 0.05).Conclusion Dexmedetomidine hydrochloride combined with sufentanil have good sedative effect and good analgesic effect for children undergoing surgery for correction of anorectal malformation.It also reduced the risk of nausea,vomiting and other adverse reactions.