中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
8期
928-932
,共5页
酰胺类%麻醉,脊尾%麻醉,全身%婴儿,新生
酰胺類%痳醉,脊尾%痳醉,全身%嬰兒,新生
선알류%마취,척미%마취,전신%영인,신생
Amides%Anesthesia,caudal%Anesthesia,general%Infant,newborn
目的 探讨罗哌卡因用于全麻下新生儿开腹术骶管阻滞的适宜浓度及剂量.方法 择期行幽门环肌切开术的患儿100例,9 ～ 30日龄,性别不限,体重2.5 ～ 4.5 kg,采用随机数字表法,将其分为5组(n=20):对照组(C组)、0.10％罗哌卡因1.0 ml/kg(0.10％L1组)、0.15％罗哌卡因1.0 ml/kg(0.15％L1组)、0.10％罗哌卡因1.2 ml/kg(0.10％L2组)和0.15％罗哌卡因1.2 ml/kg(0.15％L2组).吸入七氟醚、静脉注射顺苯磺酸阿曲库铵诱导麻醉,气管插管后行机械通气,维持PETCO230 ～ 35mmHg.C组静脉输注瑞芬太尼0.2 ～ 0.3 μg· kg-1·min-1;0.10％L2组、0.15％L1组、0.10％L2组和0.15％L2组在超声引导下于骶管内注射相应浓度和剂量的罗哌卡因.给药15 min后开始手术,吸入七氟醚,呼气末浓度0.8～ 1.0 MAC.于麻醉诱导前、术中牵拉幽门即刻、术后4、8、12和24 h时,取中心静脉血样,采用放射免疫法测定血浆皮质醇和IL-6的浓度.于术后4、8、12和24 h时采用CRIES评分评估患儿疼痛程度,CRIES评分＞3分时,给予10％水合氯醛0.5 ml/kg灌肠进行镇痛,记录水合氯醛使用情况.记录苏醒时间、气管拔管时间、PACU停留时间和出院时间.记录术中心动过缓、低血压和术后下肢运动阻滞、切口感染、切口裂开、呕吐、尿潴留等的发生情况.结果 与C组比较,0.10％L1组和0.15％L1组气管拔管时间、苏醒时间、PACU停留时间、出院时间、血浆皮质醇和IL-6的浓度、水合氯醛使用率、低血压、心动过缓、下肢运动阻滞、切口裂开和切口感染的发生率差异无统计学意义(P＞0.05),0.10％L2组和0.15L2组气管拔管时间、苏醒时间、PACU停留时间和出院时间缩短,术后血清皮质醇和IL-6的浓度、水合氯醛使用率、低血压和切口感染的发生率降低,0.15％L组和0.15％L2组呕吐和尿潴留的发生率升高(P＜0.05).与0.10％L2组比较,0.15％L2组气管拔管时间、苏醒时间、PACU停留时间、出院时间、血浆皮质醇和IL-6的浓度、水合氯醛使用率、心动过缓、低血压、下肢运动阻滞、切口感染和切口裂开的发生率差异无统计学意义(P＞0.05),呕吐和尿潴留的发生率降低(P＜0.05).结论 罗哌卡因用于全麻下新生儿开腹术骶管阻滞的适宜浓度为0.10％,适宜剂量为1.2 ml/kg.
目的 探討囉哌卡因用于全痳下新生兒開腹術骶管阻滯的適宜濃度及劑量.方法 擇期行幽門環肌切開術的患兒100例,9 ～ 30日齡,性彆不限,體重2.5 ～ 4.5 kg,採用隨機數字錶法,將其分為5組(n=20):對照組(C組)、0.10％囉哌卡因1.0 ml/kg(0.10％L1組)、0.15％囉哌卡因1.0 ml/kg(0.15％L1組)、0.10％囉哌卡因1.2 ml/kg(0.10％L2組)和0.15％囉哌卡因1.2 ml/kg(0.15％L2組).吸入七氟醚、靜脈註射順苯磺痠阿麯庫銨誘導痳醉,氣管插管後行機械通氣,維持PETCO230 ～ 35mmHg.C組靜脈輸註瑞芬太尼0.2 ～ 0.3 μg· kg-1·min-1;0.10％L2組、0.15％L1組、0.10％L2組和0.15％L2組在超聲引導下于骶管內註射相應濃度和劑量的囉哌卡因.給藥15 min後開始手術,吸入七氟醚,呼氣末濃度0.8～ 1.0 MAC.于痳醉誘導前、術中牽拉幽門即刻、術後4、8、12和24 h時,取中心靜脈血樣,採用放射免疫法測定血漿皮質醇和IL-6的濃度.于術後4、8、12和24 h時採用CRIES評分評估患兒疼痛程度,CRIES評分＞3分時,給予10％水閤氯醛0.5 ml/kg灌腸進行鎮痛,記錄水閤氯醛使用情況.記錄囌醒時間、氣管拔管時間、PACU停留時間和齣院時間.記錄術中心動過緩、低血壓和術後下肢運動阻滯、切口感染、切口裂開、嘔吐、尿潴留等的髮生情況.結果 與C組比較,0.10％L1組和0.15％L1組氣管拔管時間、囌醒時間、PACU停留時間、齣院時間、血漿皮質醇和IL-6的濃度、水閤氯醛使用率、低血壓、心動過緩、下肢運動阻滯、切口裂開和切口感染的髮生率差異無統計學意義(P＞0.05),0.10％L2組和0.15L2組氣管拔管時間、囌醒時間、PACU停留時間和齣院時間縮短,術後血清皮質醇和IL-6的濃度、水閤氯醛使用率、低血壓和切口感染的髮生率降低,0.15％L組和0.15％L2組嘔吐和尿潴留的髮生率升高(P＜0.05).與0.10％L2組比較,0.15％L2組氣管拔管時間、囌醒時間、PACU停留時間、齣院時間、血漿皮質醇和IL-6的濃度、水閤氯醛使用率、心動過緩、低血壓、下肢運動阻滯、切口感染和切口裂開的髮生率差異無統計學意義(P＞0.05),嘔吐和尿潴留的髮生率降低(P＜0.05).結論 囉哌卡因用于全痳下新生兒開腹術骶管阻滯的適宜濃度為0.10％,適宜劑量為1.2 ml/kg.
목적 탐토라고잡인용우전마하신생인개복술저관조체적괄의농도급제량.방법 택기행유문배기절개술적환인100례,9 ～ 30일령,성별불한,체중2.5 ～ 4.5 kg,채용수궤수자표법,장기분위5조(n=20):대조조(C조)、0.10％라고잡인1.0 ml/kg(0.10％L1조)、0.15％라고잡인1.0 ml/kg(0.15％L1조)、0.10％라고잡인1.2 ml/kg(0.10％L2조)화0.15％라고잡인1.2 ml/kg(0.15％L2조).흡입칠불미、정맥주사순분광산아곡고안유도마취,기관삽관후행궤계통기,유지PETCO230 ～ 35mmHg.C조정맥수주서분태니0.2 ～ 0.3 μg· kg-1·min-1;0.10％L2조、0.15％L1조、0.10％L2조화0.15％L2조재초성인도하우저관내주사상응농도화제량적라고잡인.급약15 min후개시수술,흡입칠불미,호기말농도0.8～ 1.0 MAC.우마취유도전、술중견랍유문즉각、술후4、8、12화24 h시,취중심정맥혈양,채용방사면역법측정혈장피질순화IL-6적농도.우술후4、8、12화24 h시채용CRIES평분평고환인동통정도,CRIES평분＞3분시,급여10％수합록철0.5 ml/kg관장진행진통,기록수합록철사용정황.기록소성시간、기관발관시간、PACU정류시간화출원시간.기록술중심동과완、저혈압화술후하지운동조체、절구감염、절구렬개、구토、뇨저류등적발생정황.결과 여C조비교,0.10％L1조화0.15％L1조기관발관시간、소성시간、PACU정류시간、출원시간、혈장피질순화IL-6적농도、수합록철사용솔、저혈압、심동과완、하지운동조체、절구렬개화절구감염적발생솔차이무통계학의의(P＞0.05),0.10％L2조화0.15L2조기관발관시간、소성시간、PACU정류시간화출원시간축단,술후혈청피질순화IL-6적농도、수합록철사용솔、저혈압화절구감염적발생솔강저,0.15％L조화0.15％L2조구토화뇨저류적발생솔승고(P＜0.05).여0.10％L2조비교,0.15％L2조기관발관시간、소성시간、PACU정류시간、출원시간、혈장피질순화IL-6적농도、수합록철사용솔、심동과완、저혈압、하지운동조체、절구감염화절구렬개적발생솔차이무통계학의의(P＞0.05),구토화뇨저류적발생솔강저(P＜0.05).결론 라고잡인용우전마하신생인개복술저관조체적괄의농도위0.10％,괄의제량위1.2 ml/kg.
Objective To investigate the optimum concentration and dose of ropivacaine for caudal block in the neonates undergoing laparotomy under general anesthesia.Methods One hundred pediatric patients of both sexes,aged 9-30 days,weighing 2.5-4.5 kg,scheduled for elective pyloromyotomy,were randomly divided into 5 groups (n =20 each) using a random number table:control group (group C),0.10％ ropivacaine 1.0 ml/kg group (group 0.1％ L1),0.15 ％ ropivacaine 1.0 ml/kg group (group 0.15 ％ L1),0.10 ％ ropivacaine 1.2 ml/kg group (group 0.10 ％ L2),and 0.15 ％ ropivacaine 1.2 ml/kg group (group 0.15 ％ L2).Anesthesia was induced with sevoflurane and cisatracurium.The pediatric patients were tracheally intubated and mechanically ventilated.Remifentanil was infused intravenously at 0.2-0.3 μg· kg-1 · min-1 in group C.In 0.10 ％ L1,0.15 ％ L1,0.10 ％ L2 and 0.15％L2 groups,the corresponding concentrations and doses of ropivacaine were injected into the sacral canal under the guidance of ultrasound.The operation was started at 15 min after administration and sevoflurane was inhaled and the end-tidal concentration of sevoflurane was maintained at 0.8-1.0 MAC.Before induction (T1),at pyloric muscle retraction (T2),and at 4,8,12 and 24 h after operation (T3-6),blood samples were collected from the central vein for determination of plasma concentrations of cortisol and interleukin-6 (IL-6).Pain was assessed using CRIES score at T3-6.When CRIES scores ＞ 3,10％ chloral hydrate 0.5 ml/kg was given by retention enema for analgesia,and the requirement for chloral hydrate was recorded.The emergence time,extubation time,duration of stay in post-anesthesia care unit (PACU) and hospital discharge time were recorded.Bradycardia and hypotension during operation,and development of motor block of lower extremities,infection and dehiscence of incision,vomiting,and urinary retention after operation were also recorded.Results Compared with group C,no significant changes were found in the emergence time,extubation time,duration of stay in PACU,hospital discharge time,plasma concentrations of cortisol and IL-6,the requirement for chloral hydrate,and the incidence of bradycardia,hypotension,motor block of lower extremities,and infection and dehiscence of incision in 0.10％ L1 and 0.15 ％ L1 groups,the emergence time,extubation time,duration of stay in PACU,hospital discharge time were significantly shortened,and the plasma concentrations of cortisol and IL-6,requirement for chloral hydrate,and the incidence of hypotension and infection of incision were decreased in 0.10％ L2 and 0.15％ L2 groups,and the incidence of vomiting and urinary retention was increased in 0.15％ L1 and 0.15％ L2 groups.Compared with group 0.10％ L2,the incidence of vomiting and urinary retention was significantly decreased,and no significant changes were found in the other parameters mentioned above in 0.15％ L2 group.Conclusion The optimum concentration and dose of ropivacaine are 0.10％ and 1.2 ml/kg,respectively,for caudal block in the neonates undergoing laparotomy under general anesthesia.
