不同剂量右美托咪定复合吗啡硬膜外镇痛对小儿尿道下裂术后镇痛效果的影响

目的比较小儿尿道下裂术后不同剂量右美托咪定复合吗啡硬膜外镇痛的镇痛效应和不良反应。方法择期行小儿尿道下裂手术患儿80例(ASAⅠ～Ⅱ级),随机分为4组(C组、D1组、D2组、D3组),每组20例,双盲对照观察。各组手术结束前30 min给予负荷剂量:吗啡0.02 mg/kg,镇痛泵C组:罗哌卡因100 mg+吗啡2 mg+生理盐水至100 ml,D1组:罗哌卡因100 mg+吗啡2 mg+右美托咪定0.2μg/kg+生理盐水至100 ml;D2组:罗哌卡因100 mg+吗啡2 mg+右美托咪定0.4μg/kg+生理盐水至100 ml;D3组罗哌卡因100 mg+吗啡2 mg+右美托咪定0.6μg/kg+生理盐水至100 ml;持续输注吗啡2μg/(kg.h),PCA剂量2 ml,分别记录术后各时点VAS评分,Ramsay镇静评分,麻醉药物使用量,记录患儿及家长对镇痛效果满意度和不良反应。结果 4组患者术后吗啡用药量C组明显大于D2、D3组,D1、D2、D3组术后各时点VAS评分明显低于C组,总体镇痛满意度明显高于C组;在术后各时点D1、D2、D3组镇静效果满意,术后镇痛期间不良反应恶心呕吐C组2例(10%),D1组1(5%)例,D2、D3组0例,皮肤瘙痒C组2例(10%)、D1、D2、D3组均为0例,过度镇静D3组2例(5%)4组均无呼吸抑制,心动过缓等不良反应发生。结论小剂量右美托咪定复合吗啡硬膜外镇痛可以减少硬膜外吗啡使用量,镇痛,镇静效果增强,不良反应少,其中右美托咪定剂量0.4μg/kg效果最佳。

EFFECT OF DIFFERENT DOSE OF DEXMEDETOMIDINE COMBINED WITH MORPHINE EPIDURAL ANALGESIA IN CHILDREN WITH HYPOSPADIAS OPERATION

Objective To observe the effect and adverse reaction of different dose dexmedetomidine combined with morphine epidural analgesia in children with hypospadias postoperative analgesia. Methods80 children undergoing pediatric hypospadias operation(ASAI ~ II) were randomly divided into 4 groups(group C,group D1,group D2,group D3),20 cases in each group,double blind controlled study.Every group was given a loading dose of morphine: 0.02 mg / kg,at 30 min before the end of operation.The analgesia pump in every group C: Ropivacaine 100mg + morphine 2mg + saline to 100ml,D1: Ropivacaine 100mg + morphine 2mg + dexmedetomidine0.2 u g / kg + saline to 100ml,D2: Ropivacaine100mg + morphine 2mg + dexmedetomidine0.4 u g / kg + saline to 100ml,D3: Ropivacaine 100mg + morphine 2mg + dexmedetomidine 0.6 u g / kg + saline to 100ml,continuous infusion of morphine(2ug / kg·h),2ml PCA dose were recorded.The score of VAS and Ramsay,drug usage,the satisfaction of analgesic effect and adverse reaction were recorded. ResultsThe consumption of morphine in C group was higher than that in the group D2,D3.The VAS score in each time of group D1,D2,D3 was significantly lower than that in C group,and the satisfaction in these group was higher than that of C group.Every time postoperative,the sedation effect in D1,D2,D3 group is satisfactory.Adverse reactions during postoperative analgesia,nausea and vomiting 2 cases in C group(10%),1cases in group D1(5%),D2,D3 group: 0,skin itching 2 cases in C group(10%),D1,D2,D3 group: 0,excessive sedation 2 cases in group D3(5%).4 groups had no respiratory depression and bradycardia. ConclusionLow dose dexmedetomidine combined with morphine epidural analgesia can reduce epidural morphine usage,enhance the effect of analgesia and sedation,and have little adverse reactions.The dexmedetomidine dose of 0.4 u g / kg is best.