中华妇幼临床医学杂志（电子版）
中華婦幼臨床醫學雜誌（電子版）
중화부유림상의학잡지（전자판）
CHINESE JOURNAL OF OBSTETRICS & GYNECOLOGY AND PEDIATRICS(ELECTRONIC VERSION)
2014年
2期
213-217
,共5页
罗哌卡因%腹壁神经阻滞%儿童
囉哌卡因%腹壁神經阻滯%兒童
라고잡인%복벽신경조체%인동
Ropivacaine%Transverses abdominis plane%Child
目的：观察不同浓度、相同容量的罗哌卡因在超声引导下经腹横平面腹壁神经(TAP)阻滞患儿腹腔镜术中、术后镇痛效果的差异。方法选择2012年9月至2013年3月四川大学华西医院儿童外科择期行腹腔镜下疝囊高位结扎术的120例患儿为研究对象,将其通过 SPSS 软件随机分为1组(n=30,采用0.0625%罗哌卡因),2组(n=30,采用0.125%罗哌卡因),3组(n=30,采用0.25%罗哌卡因)和空白对照组(n=30,采用生理盐水)(本研究遵循的程序符合四川大学华西医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试患儿监护人的知情同意,并与之签署临床研究知情同意书)。4组患儿年龄、体质量等一般情况比较,差异无统计学意义(P>0.05)。其均接受全身麻醉+超声引导下 TAP 阻滞。记录患儿术中生命体征变化、术后不同观察时刻 FALCC评分、Ramsay评分、追加镇痛药物情况、不良反应及家长满意情况。结果①患儿术中生命体征变化方面,1,2,3组与空白对照组比较,差异有统计学意义(P<0.05),而1组分别与2,3组比较,差异也有统计学意义(P<0.05),2,3组间比较,差异无统计学意义(P>0.05)。②1,2,3组术后0.5 h、1 h、2 h、4 h FLACC评分与空白对照组比较,差异有统计学意义(P<0.05)；而术后8 h 3组 FLACC 评分明显低于1,2组和空白对照组(P<0.05)；4组间术后24 h FLACC评分比较,差异无统计学意义(P>0.05)。③1,2,3组术后0.5 h、1 h Ramsay评分与空白对照组比较,差异有统计学意义(P<0.05)；2,3组术后2 h、4 h Ramsay评分与1组和空白对照组比较,差异有统计学意义(P<0.05)。结论1~3岁行腹腔镜下疝囊高位结扎术患儿应用超声引导下行 TAP 阻滞,选用罗哌卡因为局部麻醉药物,其术中、术后镇痛效果明确。相同容量下,高浓度局部麻醉药物较低浓度镇痛效果更完善、持续时间更长。适当降低罗哌卡因浓度而增加其药物容量,可能会获得更完善和安全的镇痛效果。
目的：觀察不同濃度、相同容量的囉哌卡因在超聲引導下經腹橫平麵腹壁神經(TAP)阻滯患兒腹腔鏡術中、術後鎮痛效果的差異。方法選擇2012年9月至2013年3月四川大學華西醫院兒童外科擇期行腹腔鏡下疝囊高位結扎術的120例患兒為研究對象,將其通過 SPSS 軟件隨機分為1組(n=30,採用0.0625%囉哌卡因),2組(n=30,採用0.125%囉哌卡因),3組(n=30,採用0.25%囉哌卡因)和空白對照組(n=30,採用生理鹽水)(本研究遵循的程序符閤四川大學華西醫院人體試驗委員會所製定的倫理學標準,得到該委員會批準,徵得受試患兒鑑護人的知情同意,併與之籤署臨床研究知情同意書)。4組患兒年齡、體質量等一般情況比較,差異無統計學意義(P>0.05)。其均接受全身痳醉+超聲引導下 TAP 阻滯。記錄患兒術中生命體徵變化、術後不同觀察時刻 FALCC評分、Ramsay評分、追加鎮痛藥物情況、不良反應及傢長滿意情況。結果①患兒術中生命體徵變化方麵,1,2,3組與空白對照組比較,差異有統計學意義(P<0.05),而1組分彆與2,3組比較,差異也有統計學意義(P<0.05),2,3組間比較,差異無統計學意義(P>0.05)。②1,2,3組術後0.5 h、1 h、2 h、4 h FLACC評分與空白對照組比較,差異有統計學意義(P<0.05)；而術後8 h 3組 FLACC 評分明顯低于1,2組和空白對照組(P<0.05)；4組間術後24 h FLACC評分比較,差異無統計學意義(P>0.05)。③1,2,3組術後0.5 h、1 h Ramsay評分與空白對照組比較,差異有統計學意義(P<0.05)；2,3組術後2 h、4 h Ramsay評分與1組和空白對照組比較,差異有統計學意義(P<0.05)。結論1~3歲行腹腔鏡下疝囊高位結扎術患兒應用超聲引導下行 TAP 阻滯,選用囉哌卡因為跼部痳醉藥物,其術中、術後鎮痛效果明確。相同容量下,高濃度跼部痳醉藥物較低濃度鎮痛效果更完善、持續時間更長。適噹降低囉哌卡因濃度而增加其藥物容量,可能會穫得更完善和安全的鎮痛效果。
목적：관찰불동농도、상동용량적라고잡인재초성인도하경복횡평면복벽신경(TAP)조체환인복강경술중、술후진통효과적차이。방법선택2012년9월지2013년3월사천대학화서의원인동외과택기행복강경하산낭고위결찰술적120례환인위연구대상,장기통과 SPSS 연건수궤분위1조(n=30,채용0.0625%라고잡인),2조(n=30,채용0.125%라고잡인),3조(n=30,채용0.25%라고잡인)화공백대조조(n=30,채용생리염수)(본연구준순적정서부합사천대학화서의원인체시험위원회소제정적윤리학표준,득도해위원회비준,정득수시환인감호인적지정동의,병여지첨서림상연구지정동의서)。4조환인년령、체질량등일반정황비교,차이무통계학의의(P>0.05)。기균접수전신마취+초성인도하 TAP 조체。기록환인술중생명체정변화、술후불동관찰시각 FALCC평분、Ramsay평분、추가진통약물정황、불량반응급가장만의정황。결과①환인술중생명체정변화방면,1,2,3조여공백대조조비교,차이유통계학의의(P<0.05),이1조분별여2,3조비교,차이야유통계학의의(P<0.05),2,3조간비교,차이무통계학의의(P>0.05)。②1,2,3조술후0.5 h、1 h、2 h、4 h FLACC평분여공백대조조비교,차이유통계학의의(P<0.05)；이술후8 h 3조 FLACC 평분명현저우1,2조화공백대조조(P<0.05)；4조간술후24 h FLACC평분비교,차이무통계학의의(P>0.05)。③1,2,3조술후0.5 h、1 h Ramsay평분여공백대조조비교,차이유통계학의의(P<0.05)；2,3조술후2 h、4 h Ramsay평분여1조화공백대조조비교,차이유통계학의의(P<0.05)。결론1~3세행복강경하산낭고위결찰술환인응용초성인도하행 TAP 조체,선용라고잡인위국부마취약물,기술중、술후진통효과명학。상동용량하,고농도국부마취약물교저농도진통효과경완선、지속시간경장。괄당강저라고잡인농도이증가기약물용량,가능회획득경완선화안전적진통효과。
Objective To evaluate analgesic quality of ropivacaine with three different concentrations in children receiving transverses abdominis plane(TAP)block.Methods From September 2012 to March 2013,a total of 120 children undergoing laparoscopic high ligation of inguinal hernia combined general and TAP block were included in the study,and randomly divided into group 1(n=30,0.062 5% ropivacaine), group 2(n=30,0.125% ropivacaine),group 3 (n=30,0.25% ropivacaine)and control group (n=30, saline).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Hosipital.Informed consent was obtained from each participates′parents.Intraoperative vital signs,postoperative FLACC scores and Ramsay scores were assessed up to 24 h after the operation.The need for additional analgesia agents,parents′s degree of satisfaction and the incidence of anesthesia-related complications were recorded.Results ① There had significant differences in vital signs between group 1 , 2,3 and control group respectively(P<0.05),and group 1 had obviously larger HR changes than that of group 2,3(P<0.05).No significant difference was found between group 2 and group 3 in HR changes (P>0.05).② There also had significant differences in FLACC scores at 0.5 h,1 h,2 h,4 h after operation between group 1,2,3 and control group respectively(P<0.05).Compared to other 3 groups,FLACC scores in group 3 at 8 h was obviously lower.③The Ramsay scores of control group within 1 h after operation were lower than other 3 groups .Conclusions Using the same capacity but high concentration of local anesthetic can provided the longer duration of analgesia,compared with the same capacity but low concentration of local anesthetic.Increased capacity of lower concentrations of ropivacaine will be provid similar efficacy,and may lead to a lower risk of local anaesthetic toxicity.
