本文選題：右美托咪定　切入點：羅哌卡因　出處：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:臨床上小兒手外傷手術(shù)常用的局部麻醉方法為臂叢神經(jīng)阻滯,以往常采用利多卡因,但患兒麻醉持續(xù)時間較短,不利于患兒圍手術(shù)期鎮(zhèn)痛管理,為此,為了延長手外傷患兒的鎮(zhèn)痛時間,保證鎮(zhèn)痛效果,采用右美托咪定復合羅哌卡因臂叢神經(jīng)腋路給藥方法。本次研究比較羅哌卡因和右美托咪定復合羅哌卡因臂叢神經(jīng)阻滯用于小兒圍術(shù)期鎮(zhèn)痛管理。方法:選擇30例手外傷患兒,年齡2-6歲,體重7-25公斤,ASAI或II級,術(shù)前4周未見呼吸道感染,無手術(shù)禁忌。采用隨機數(shù)字表法,隨機分為羅哌卡因組(L組)和右美托咪定復合羅哌卡因組(D組),每組15例�；純好嬲治�8%七氟醚,吸入麻醉成功后插入喉罩,保留自主呼吸,七氟醚調(diào)整為3%。靜脈予以抗膽堿藥阿托品0.15mg/kg,糖皮質(zhì)激素地塞米松0.2mg/kg。后行B超定位神經(jīng)刺激儀引導下腋路臂叢神經(jīng)阻滯。羅哌卡因組手外傷患兒臂叢神經(jīng)腋路注入0.25%羅哌卡因1ml/kg,右美托咪定復合羅哌卡因組手外傷患兒予以0.25%羅哌卡因1ml/kg復合右美托咪定1μg/kg。手術(shù)中,持續(xù)吸入2%七氟醚。手術(shù)后停用七氟醚。術(shù)后記錄兩組患兒臂叢神經(jīng)阻滯起效時間、臂叢神經(jīng)鎮(zhèn)痛持續(xù)時間、術(shù)后躁動發(fā)生率等不良反應(yīng)發(fā)生情況。結(jié)果:羅哌卡因組和右美托咪定復合羅哌卡因組患兒年齡、體重、性別構(gòu)成、手術(shù)時間比較差異并無統(tǒng)計學意義(P0.05);羅哌卡因組的臂叢神經(jīng)阻滯起效時間為(13.0±3.5)min,右美托咪定復合羅哌卡因組的臂叢神經(jīng)阻滯起效時間為(10.4±2.3)min(P0.05);羅哌卡因組的蘇醒時間為(13.1±8.7)min,右美托咪定復合羅哌卡因組的蘇醒時間為(13.5±2.4)min(P0.05);右美托咪定復合羅哌卡因組的持續(xù)鎮(zhèn)痛時間為(654.0±31.9)min,羅哌卡因組的鎮(zhèn)痛時間為(545.0±21.5)min,右美托咪定復合羅哌卡因組的持續(xù)鎮(zhèn)痛時間明顯大于羅哌卡因組(P0.05);羅哌卡因組和右美托咪定復合羅哌卡因組患兒FLACC分值比較具有顯著意義(P0.05);羅哌卡因組的術(shù)后躁動發(fā)生率為53.33%,右美托咪定復合羅哌卡因組的術(shù)后躁動發(fā)生率為20.00%(P0.05).羅哌卡因組不良反應(yīng)發(fā)生率為20%,右美托咪定復合羅哌卡因組不良反應(yīng)發(fā)生率為6.67%(P0.05)。結(jié)論:與單純使用羅哌卡因麻醉相比,采用右美托咪定復合羅哌卡因臂叢神經(jīng)阻滯能夠縮短臂叢神經(jīng)起效時間,延長鎮(zhèn)痛持續(xù)時間,不影響蘇醒時間。右美托咪定復合羅哌卡因組FLACC評分分值減少,鎮(zhèn)痛效果更明顯。同時,不增加不良反應(yīng),用于手外傷患兒圍手術(shù)期鎮(zhèn)痛安全性、有效性較高,有利于患兒的術(shù)后恢復。
[Abstract]:Objective: the common local anesthetic method in pediatric hand trauma surgery is brachial plexus block, which is usually treated with lidocaine, but the duration of anesthesia in children is shorter, which is not conducive to the perioperative analgesia management of children.In order to prolong the analgesic time and ensure the analgesic effect, dexmetomidine combined with ropivacaine in brachial plexus was used.In this study, ropivacaine and dexmetomidine combined with ropivacaine were compared for perioperative analgesia management in children.Methods: 30 children with hand trauma, aged 2-6 years, weighing 7-25 kg ASAI or II, had no respiratory tract infection at 4 weeks before operation and had no contraindication.The patients were randomly divided into ropivacaine group (n = 15) and dexmetomidine combined with ropivacaine group (n = 15).The mask inhaled 8% sevoflurane, inserted the laryngeal mask after anesthesia, and kept breathing autonomously. Sevoflurane was adjusted to 3.Atropine 0.15 mg / kg, glucocorticoid dexamethasone 0.2 mg / kg.The nerve block of axillary brachial plexus guided by B-ultrasound localizing nerve stimulator was performed.In the ropivacaine group, 0.25% ropivacaine 1 ml / kg was injected into the brachial plexus nerve of the children with hand trauma. The patients in the dexmetomidine combined with ropivacaine group were given 0.25% ropivacaine 1ml/kg combined with dexmetoimidine 1 渭 g / kg.During the operation, 2% sevoflurane was inhaled continuously.Sevoflurane was discontinued after operation.The onset time of brachial plexus block, the duration of brachial plexus analgesia and the incidence of postoperative restlessness were recorded.Results: the age, body weight and sex composition of ropivacaine group and dexmetomidine combined ropivacaine group,The time of brachial plexus block was 13.0 鹵3.5 min in ropivacaine group, 10.4 鹵2.3 min in ropivacaine group and 10.4 鹵2.3 min in ropivacaine group.(13.1鹵8.7)min,鍙崇編鎵樺挭瀹氬鍚堢綏鍝屽崱鍥犵粍鐨勮嫃閱掓椂闂翠負(13.5鹵2.4)min(P0.05);鍙崇編鎵樺挭瀹氬鍚堢綏鍝屽崱鍥犵粍鐨勬寔緇晣鐥涙椂闂翠負(654.0鹵31.9)min,緗楀搶鍗″洜緇勭殑闀囩棝鏃墮棿涓，

本文編號：1704535