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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (01) : 51 -55. doi: 10.3877/cma.j.issn.1673-5250.2017.01.009

所属专题： 文献；

论著

左布比卡因联合右美托咪定眶下神经阻滞在儿童唇裂修复术后的镇痛效果
黄俊祥1, 田航1, 陈茜1, 李碧莲1, 邱倩琪1, 徐颖怡1, 张志意1, 宋兴荣1,†()   
  1. 1. 510120　广州市妇女儿童医疗中心麻醉科
  • 收稿日期:2016-11-26 修回日期:2017-01-25 出版日期:2017-02-01
  • 通信作者: 宋兴荣

Postoperative analgesia effect of levobupivacaine combined with dexmedetomidine in infraorbital nerve block for cleft lip repair in children

Junxiang Huang1, Hang Tian1, Xi Chen1, Bilian Li1, Qianqi Qiu1, Yingyi Xu1, Zhiyi Zhang1, Xingrong Song1,†()   

  1. 1. Department of Anesthesiology, Guangzhou Women and Children′s Medical Center, Guangzhou 510120, Guangdong Province, China
  • Received:2016-11-26 Revised:2017-01-25 Published:2017-02-01
  • Corresponding author: Xingrong Song
  • About author:
    Corresponding author: Song Xingrong, Email:
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黄俊祥, 田航, 陈茜, 李碧莲, 邱倩琪, 徐颖怡, 张志意, 宋兴荣. 左布比卡因联合右美托咪定眶下神经阻滞在儿童唇裂修复术后的镇痛效果[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(01): 51-55.

Junxiang Huang, Hang Tian, Xi Chen, Bilian Li, Qianqi Qiu, Yingyi Xu, Zhiyi Zhang, Xingrong Song. Postoperative analgesia effect of levobupivacaine combined with dexmedetomidine in infraorbital nerve block for cleft lip repair in children[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(01): 51-55.

目的

探讨左布比卡因联合右美托咪定应用于眶下神经阻滞，对儿童唇裂修复术后的镇痛效果。

方法

选择2016年4月至7月，在广州市妇女儿童医疗中心确诊为先天性唇裂，并进行唇裂修复术的60例患儿为研究对象。采用随机数字表法，将其随机平均分为3组，LD组(采用左布比卡因联合右美托咪定进行眶下神经阻滞)、L组(采用左布比卡因进行眶下神经阻滞)和对照组(采用生理盐水进行眶下神经阻滞)，每组各20例患儿。采用FLACC量表法，进行患儿术后疼痛评分。统计学比较3组患儿术后不同时间点(0.5、1、2、4、8、12 h)FLACC疼痛评分，以及镇痛药物使用情况及不良反应情况。本研究已获得广州市妇女儿童医疗中心伦理评审委员会批准，并与患儿家长签署知情同意书。

结果

①3组先天性唇裂患儿年龄、性别构成比、体重及手术时间比较，差异均无统计学意义(P>0.05)。②LD组患儿术后0.5、1 h的FLACC疼痛评分分别较L组及对照组低，L组患儿术后0.5、1 h的FLACC疼痛评分均较对照组低，并且差异均有统计学意义(P<0.05)。3组患儿术后2、4、8及12 h的FLACC疼痛评分比较，差异均无统计学意义(P>0.05)。③LD组和L组患儿有效镇痛时间均分别较对照组长，LD组较L组更长；LD组和L组对乙酰氨基酚使用率及舒芬太尼使用总量均分别较对照组低或少，LD组较L组更低或更少，并且上述差异均有统计学意义(P<0.05)。④3组患儿术后不良反应率比较，差异无统计学意义(χ2＝3.25，P＝0.420)。

结论

左布比卡因联合右美托咪定进行眶下神经阻滞，对儿童唇裂修复术后的镇痛效果安全、有效。

关键词: 左布比卡因, 右美托咪定, 神经传导阻滞, 唇裂, 镇痛, 儿童
Objective

To investigate the postoperative analgesic effect of levobupivacaine combined with dexmedetomidine applied to infraorbital nerve block for cleft lip repair in children.

Methods

A total of 60 children who were diagnosed as congenital cleft lip and underwent cleft lip repair surgery in Guangzhou Women and Children′s Medical Center from April to July 2016 were selected as study objects. According to the random number table, the 60 patients were divided into 3 groups, LD group (received levobupivacaine and dexmedetomidine for infraorbital nerve block), L group (received levobupivacaine for infraorbital nerve block), and control group (received normal saline solution for infraorbital nerve block), 20 cases for each group. FLACC scale values were used to evaluate the postoperative pain. The FLACC scores at 0.5, 1, 2, 4, 8, 12 h after cleft lip repair, the analgesics drug requirements and adverse reactions were compared among 3 groups statistically. This study has been approved by the ethics committee of Guangzhou Women and Children′s Medical Center and all the parents of participants signed the informed consents.

Results

①There were no significant differences among 3 groups of congenital cleft lip children in age, gender constituent ratio, body weight and durations of surgery (P>0.05). ②The FLACC scores of 0.5 and 1 h after operation in LD group were lower than those of L group and control group, respectively, the FLACC scores of 0.5 and 1 h after operation in L group were lower than those of control group, and all the differences above were statistically significant (P<0.05). There were no significant differences among 3 groups in FLACC scores of 2, 4, 8 and 12 h after operation (P>0.05). ③ Effective analgesia time in LD and L group were longer than that of control group, respectively, effective analgesia time in LD group was longer than that of L group, and all the differences were statistically significant (P<0.05). Acetaminophen use rates and total dose of sufentanil in LD and L group were lower or less than those of control group, respectively, acetaminophen use rates and total dose of sufentanil in LD group were lower or less than those of L group, and all the differences were statistically significant (P<0.05). ④ There were no significant differences among 3 groups in adverse reaction rate (χ2=3.25, P=0.420).

Conclusion

Levobupivacaine combined with dexmedetomidine for infraorbital nerve block analgesia is safe and effective for children after cleft lip repair.

Key words: Levobupivacaine, Dexmedetomidine, Nerve block, Cleft lip, Analgesia, Child
表1 3组先天性唇裂患儿一般临床资料比较
组别 例数 年龄(月,±s) 性别[例数(%)] 体重(kg, ±s) 手术时间(min, ±s)
男 女
LD组 20 12.3±6.2 11(55.0) 9(45.0) 10.5±3.9 61.6±12.7
L组 20 16.2±7.5 12(60.0) 8(40.0) 10.7±3.5 57.9±13.5
对照组 20 15.5±6.3 13(65.0) 7(35.0) 11.0±4.2 65.4±14.3
检验值 ? F＝0.51 χ2＝1.56 F＝0.85 F＝1.43
P值 ? 0.780 0.370 0.520 0.220
表2 3组先天性唇裂患儿术后不同时间点FLACC疼痛评分比较(分,±s)
组别 例数 0.5 h 1 h 2 h 4 h 8 h 12 h
LD组 20 1.8±0.3 2.2±0.2 2.8±0.5 3.3±0.2 3.4±0.4 4.5±0.6
L组 20 2.4±0.4 2.6±0.3 3.1±0.4 3.5±0.6 3.7±0.7 4.8±0.6
对照组 20 3.0±0.5 3.1±0.4 4.3±0.5 4.8±0.8 5.2±1.0 6.4±0.9
F值 ? 146.50 32.60 0.65 0.52 0.45 0.72
P值 ? 0.007 0.009 0.120 0.260 0.380 0.290
表3 3组先天性唇裂患儿有效镇痛时间及镇痛药物使用情况比较
组别 例数 有效镇痛时间(min, ±s) 对乙酰氨基酚使用率[例数(%)] 舒芬太尼使用总量(μg, ±s)
LD组 20 297±21 11(55.0) 6.5±7.8
L组 20 246±63 13(65.0) 12.5±9.4
对照组 20 141±72 15(75.0) 18.2±6.5
检验值 ? F＝14.82 χ2＝19.81 F＝18.54
P值 ? 0.007 0.031 0.003
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