2018 年第 1 期 第 13 卷

右美托咪定骶管内注射用于小儿先天性心脏病手术镇痛的临床研究

作者：李渭敏仲吉英李艳雪何鑫敏

英文作者：

单位：528000广东省佛山市第一人民医院（中山大学附属佛山医院）麻醉科    

英文单位：

关键词：先天性心脏病手术；右美托咪定；骶管镇痛

英文关键词：

• 摘要：

• 【摘要】目的    探讨右美托咪定骶管内注射用于小儿先天性心脏病手术镇痛的效果和安全性。方法    选择2016年5月至2017年4月于广东省佛山市第一人民医院接受择期房间隔缺损或室间隔缺损修补术的患儿70例，美国麻醉医师协会分级Ⅰ～Ⅱ级，使用随机数字表将患儿随机分为右美托咪定组和吗啡组，每组35例。2组基础麻醉后分别在骶管注射右美托咪定1.0 μg/kg或吗啡100 μg/kg，相同麻醉方案下行先天性心脏病手术，并接受术后48 h护士控制静脉镇痛治疗。比较2组术后1、4、8、12、24、48 h面部表情加行为综合评分法（FLACC）疼痛评分和Ramsay镇静评分，术后24、48 h镇痛药物舒芬太尼消耗量、静脉镇痛泵有效按压和无效按压次数及不良反应发生情况。结果    2组患儿术后不同时点FLACC疼痛评分组间比较，差异均无统计学意义（P=0.26）。术后早期1、4、8 h吗啡组Ramsay镇静评分高于右美托咪定组［3(2,3)分比2(1,3)分、4(3,5)分比3(2,3)分、3(3,4)分比2(2,3)分］，差异均有统计学意义（均P＜0.05），术后12、24、48 h时2组患儿Ramsay镇静评分组间比较，差异均无统计学意义（均P＞0.05）。2组患儿术后24、48 h舒芬太尼消耗量、静脉镇痛泵有效按压次数组间比较，差异均无统计学意义（均P＞0.05）。右美托咪定组术后24、48 h静脉镇痛泵无效按压次数均明显多于吗啡组［2(0,3)次比0(0,1)次、2(0,3)次比1(0,1)次］，差异均有统计学意义（均P＜0.05）。2组均未发生严重不良反应，右美托咪定组恶心呕吐和总不良反应发生率均明显低于吗啡组［8.6%(3/35)比17.1%(6/35)、8.6%(3/35)比31.4%(11/35)］，差异均有统计学意义（均P＜0.05）。结论    右美托咪定骶管注射用于小儿先天性心脏病手术镇痛效果良好，虽未减少舒芬太尼用量，但不良反应发生率较低，安全性较高。

• Clinical research on dexmedetomidine caudal analgesia in children with congenital heart disease surgery

  Li Weimin, Zhong Jiying, Li Yanxue, He Xinmin

  Department of Anesthesiology, Foshan First People′s Hospital（Foshan Hospital Affiliated to Sun Yat-sen University）, Guangdong Province, Foshan 528000, China

  Corresponding author: Zhong Jiying, Email: 570302335@qq.com

  【Abstract】Objective     To investigate the effectiveness and safety of dexmedetomidine caudal analgesia in children with congenital heart disease surgery. Methods    Seventy children undergoing elective atrial/ventricular septal defect repair（American Society of Anesthesiologists Ⅰ-Ⅱ） from May 2016 to April 2017 in Foshan First People′s Hospital were randomly divided into dexmedetomidine group and morphine group, with 35 cases in each group. Patients in dexmedetomidine group and morphine group were respectively treated by caudal analgesia with dexmedetomidine 1 μg/kg and morphine 100 μg/kg after basal anesthesia; all patients had nurse-controlled intravenous analgesia after operation. The Face, Legs, Activity, Cry, Consolability（FLACC） score and the Ramsay sedation score were assessed 1 h（T1）, 4 h（T2）, 8 h（T3）, 12 h（T4）, 24 h（T5）, 48 h（T6） after operation. Sufentanil consumption, demand times of intravenous analgesia and occurrence of adverse reactions in 24, 48 h after operation were analyzed. Results    The FLACC score showed no significant difference between groups（P=0.26）. The Ramsay sedation scores at T1, T2, T3 in morphine group were significantly higher than those in dexmedetomidine group［3(2,3)points vs 2(1,3) points, 4(3,5) points vs 3(2,3) points, 3(3,4)points vs 2(2,3)points］(P＜0.05); the Ramsay sedation scores at T4, T5, T6 had no significant differences between groups(P＞0.05). Sufentanil consumption and demand times of effective intravenous analgesia had no significant differences between groups(P＞0.05). Demand times of ineffective intravenous analgesia in 24, 48 h after operation in dexmedetomidine group were significantly more than those in morphine group［2(0,3)times vs 0(0,1)times, 2(0,3)times vs 1(0,1)times］(P＜0.05). There was no serious adverse reaction in both groups. Incidences of nausea and vomiting and total incidence of adverse reactions in dexmedetomidine group were significantly lower than those in morphine group［8.6%(3/35) vs 17.1%(6/35), 8.6%(3/35) vs 31.4%(11/35)］(P＜0.05). Conclusion    Dexmedetomidine caudal analgesia is effective in children with congenital heart disease surgery; it may not reduce the use of sufentanil but can reduce adverse reaction, and improve security.

  【Key words】Congenital heart disease surgery；Dexmedetomidine；Caudal analgesia

  【Fund program】Science and Technology Innovation Special Fund Project of Foshan, Guangdong Province（2014AG10010）