小儿尿道下裂修补术后硬膜外自控镇痛与静脉自控镇痛的效果观察(1)
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【摘要】 目的 比较盐酸曲马多+罗哌卡因硬膜外自控镇痛与盐酸曲马多+芬太尼静脉自控镇痛用于小儿尿道下裂修补术后的效果及不良反应。方法 60例ASA I~II级、年龄3~8岁的尿道下裂患儿,随机分为两组,每组30例。A组(n=30):盐酸曲马多+罗哌卡因硬膜外自控镇痛(PCEA),术毕前30 min硬膜外给予盐酸曲马多0.5 mg/kg+0.125%罗哌卡因3 ml,术毕盐酸曲马多1 mg/kg+氟哌利多0.05 mg/kg+0.125%布比卡因,加生理盐水至100 ml,持续泵入1 ml/h,PCA 1 ml/次,锁定时间为10 min;B组(n=30):盐酸曲马多+芬太尼静脉自控镇痛(PCIA),盐酸曲马多1 mg/kg+芬太尼0.001 mg/kg+氟哌利多0.05 mg/kg,加生理盐水至100 ml,术毕静脉泵入1 ml/h,PCA 1 ml/次,锁定时间10 min。观察术后采用视觉模拟评分(VAS)分别记录两组术后1 h、3 h、6 h、12 h、24 h、48 h的镇痛效果,同时记录心率、血氧饱和度及不良反应的发生率。结果 A、B组的VAS评分、心率无明显差异(P>0.05);B组在术后1 h、3 h血氧饱和度明显低于A组(P<0.05),在其他时间与A组无明显差异(P>0.05);B组有5例嗜睡,6例出现轻度恶心呕吐(P<0.01)。结论 小儿尿道下裂术后PCEA与PCIA的效果相当,但PCIA的副作用稍大,PCEA更合适。
【关键词】
尿道下裂;硬膜外自控镇痛;静脉自控镇痛
Observation on PCEA and PCIA after hypospadias surgery in pediatric patients
LI Zhiping,LIN Yongfeng.People’s Hospital of Dongguan,Guangdong,Dongguan 523018,China
【Abstract】 Objective To study the analgesia and side effects among hcl tromadol combined ropivacaine epidural analgesia,hcl tromadol combined fentanyl intravenous analgesia after hypospadias surgery in pediatric patients.Methods Sixty ASA I~II patients aged 3~8 yr undergoing hypospadias surgery were randomly allocated into two groups(n=30).Group A(PCEA,n=30):administrated with 3 ml of 1 mg/kg hcl tromadol and 0.125%ropivacaine through epidural catheter 30 min before the ending of surgery,0.5 mg/kg hcl tromadol、0.125%ropivacaine and 0.05 mg/kg droperidol were mixed to 100 ml,administrated through epidural catheter;Group B(PCIA,n=30):1 mg/kg hcl tromadol 、0.001 mg/kg fentanyl and 0.05 mg/kg droperidol were mixed to 100 ml,administrated through venoclysis;Two groups were used the same arguments of continuous dose 1 ml/h 、PCA dose 1 ml and limit time 10 min.Analgesia was evaluated using VAS,the analgesia、HR 、SpO2 and side effects were recorded at 1 h、3 h、6 h、12 h、24 h、48 h after operation.Results The VAS score and HR had no difference between group A and group B(P>0.05);Group B were lower than group A on SpO2 at 1 h and 3 h after operation(P<0 ......
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