【摘要】：目的：觀察嬰幼兒腹部手術(shù)后經(jīng)骶管單次注入布比卡因復(fù)合芬太尼的鎮(zhèn)痛效果，探討該方法的安全性及實(shí)用性。 方法：80例行擇期腹部手術(shù)患兒，隨機(jī)分為4組，每組20例。A組術(shù)畢經(jīng)骶管注入0.1%布比卡因+芬太尼0.1μg/kg，B組術(shù)畢經(jīng)骶管注入0.1%布比卡因，C組術(shù)畢經(jīng)骶管注入芬太尼0.1μg/kg，D組骶管不注入任何藥物，A、B、C組注藥量為1.0ml/kg。記錄各組患兒入室時(T0)、術(shù)畢時(T1)、氣管拔管時(T2)、氣管拔管后30min(T3)及術(shù)后2h(T4)、4h(T5)、8h(T6)、12h(T7)、24h(T8)、48h(T9)的收縮壓（SBP）、舒張壓（DBP）、呼吸頻率（RR）、心率（HR）、脈搏血氧飽和度（SpO_2）。記錄手術(shù)時間、麻醉時間及住院時間。用FLACC法進(jìn)行鎮(zhèn)痛評分并隨訪不良反應(yīng)的發(fā)生例數(shù)。 結(jié)果：患兒的性別、年齡、體重、手術(shù)種類、手術(shù)時間、麻醉時間及住院時間，四組間均無顯著性差異（P＞0.05）。組間比較：患兒FLACC評分在T4時A、B、C組均低于D組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；在T5時A、B組低于C、D組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；在T6時A組低于B、C、D組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；T2、T3、T4、T5、T6、T7患兒HR A組慢于B、C、D組。組內(nèi)比較：A組在T4、T5、T6時點(diǎn)患兒FLACC評分低于T2時點(diǎn)，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；A組在T2時及T2后HR慢于T0，B、C、D組T2時及T2后HR快于T0，，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）�；純篠BP、DBP、RR、SpO_2各時間點(diǎn)各組差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），均在正常范圍之內(nèi)。各組均有術(shù)后惡心嘔吐、皮膚瘙癢等不良反應(yīng)，但差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），各組未發(fā)現(xiàn)尿潴留、運(yùn)動阻滯及呼吸抑制，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論： 1.經(jīng)骶管單次注入布比卡因可為嬰幼兒腹部手術(shù)后提供4小時左右滿意的鎮(zhèn)痛效果 2.布比卡因復(fù)合芬太尼用藥可有效延長術(shù)后鎮(zhèn)痛時間至8小時左右 3.嬰幼兒腹部手術(shù)后單次將局麻藥復(fù)合芬太尼注入骶管的方法安全有效。
[Abstract]:Objective: to observe the analgesic effect of bupivacaine combined with fentanyl once injected into sacral canal after abdominal operation in infants and to explore the safety and practicability of this method. Methods: 80 children undergoing elective abdominal surgery were randomly divided into 4 groups. In group A, 0.1% bupivacaine fentanyl 0.1 渭 g 路kg ~ (-1) was injected through sacral canal at the end of operation. In group C, 0.1% bupivacaine was injected through sacral canal at the end of operation, and no drug was injected into sacral canal in group D at the end of operation. Systolic pressure (SBP), diastolic pressure (DBP), (DBP), respiratory frequency (RR), (HR), pulse oxygen saturation (SpO_2) were recorded at the time of entry (T0), end of operation (T1), tracheal extubation (T2), 30min (T3) after tracheal extubation and 2h (T4), 4h (T5), 8h (T6), 12h (T7), 24h (T8), 48h (T9). Time of operation, duration of anesthesia and length of stay were recorded. FLACC method was used to score analgesia and follow up the incidence of adverse reactions. Results: there was no significant difference in sex, age, body weight, type of operation, operation time, anesthetic time and hospitalization time among the four groups (P > 0.05). Comparison between groups: the FLACC score of group A at T4 was lower than that of group D (P < 0. 05), and that of group B was lower than that of group C at T5 (P < 0. 05), and that of group A was lower than that of group D at T6 (P < 0. 05). Group HR A was slower than group D in group T _ 2, T _ 3, T _ 4, T _ 5, T _ 6 and T _ 7. Intragroup comparison: the FLACC score of group A was lower than that of T 2 at T 4, T 5 and T 6, and the difference was statistically significant (P < 0 05). The HR of group A was slower than that of T 2 and HR after T 2 in T 2 and T 2 group (P < 0 05). There was no significant difference in SBP,DBP,RR,SpO_2 in all groups (P > 0. 05), all of them were within normal range. Postoperative nausea and vomiting, pruritus and other adverse reactions were found in all groups, but the difference was not statistically significant (P > 0.05). There was no significant difference in urinary retention, motor block and respiratory inhibition in all groups (P > 0.05). Conclusion: 1. Single injection of bupivacaine through sacral canal can provide 4 hours of satisfactory analgesic effect for infants after abdominal operation. Bupivacaine combined with fentanyl can effectively prolong postoperative analgesia time to about 8 hours. It is safe and effective to inject local anesthetic and fentanyl into sacral canal after abdominal operation in infants.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R726.1

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