摘要
目的 评价静脉输注小剂量右美托咪定联合头皮神经阻滞用于学龄前儿童开颅术后镇痛的效果.方法 本研究为前瞻性、随机对照双盲试验.选择首都医科大学附属北京天坛医院2022年5月至2023年12月择期行神经外科手术患儿120例,年龄3～7岁,ASA分级Ⅰ-Ⅲ级,BMI 12～25 kg/m2.采用随机数字表法分为2组(n=60):静脉输注小剂量右美托咪定联合头皮神经阻滞组(Dex+SNB组)和单纯头皮神经阻滞组(SNB组).Dex+SNB组经24 h静脉输注右美托咪定0.2 vg·kg-1·h-1(用生理盐水稀释至50 ml),SNB组经24 h静脉输注等容量生理盐水.术后常规使用电子静脉镇痛泵,药物配方:舒芬太尼2 μg/kg+昂丹司琼0.3 mg/kg,用生理盐水配至100 ml,无背景输注,单次给药剂量2 ml,锁定时间30 min.采用FLACC量表评价疼痛程度,FLACC评分≥4时,先由PACU、ICU或病房护理人员按压镇痛泵,若无效则口服对乙酰氨基酚15 mg/kg补救镇痛.记录术后1 h内、2 h内、4 h内、18 h内、24 h内和48 h内舒芬太尼消耗量;分别于术后1、2、4、18、24和48 h时行疼痛FLACC评分、Richmond躁动-镇静评分(RASS评分)和康奈尔儿童谵妄评分(CAPD评分),记录术后48 h内中重度疼痛(疼痛FLACC评分≥4分)、补救镇痛、镇静过度(RASS评分≤-3分)、躁动(RASS评分≥2分)、谵妄(CAPD评分＞9分)和睡眠质量不佳(睡眠质量评分≤2分)的发生情况.记录术后48 h内药物相关和手术相关不良反应发生情况.结果 最终SNB组纳入56例患儿,Dex+SNB组纳入55例患儿.与SNB组比较,Dex+SNB组术后2h内、4 h内、18h内和24 h内舒芬太尼消耗量减少,术后18 h时疼痛FLACC评分降低,术后第1天睡眠质量不佳发生率降低(P＜0.05),术后中重度疼痛、过度镇静、躁动、谵妄和不良反应发生率差异无统计学意义(P＞0.05).结论 相对于单纯头皮神经阻滞而言,静脉输注小剂量右美托咪定联合头皮神经阻滞用于开颅手术学龄前儿童术后镇痛,可减少阿片类药物用量,提高睡眠质量.
Abstract
Objective To evaluate the analgesic effect of continuous infusion of low-dose dexme-detomidine combined with scalp nerve block after craniotomy in preschool children.Methods This single-center,prospective,double-blind,randomized controlled study included 120 pediatric patients,aged 3-7 yr,of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ,with body mass index of 12-25 kg/m2,who underwent elective craniotomy at Beijing Tiantan Hospital from May 2022 to December 2023.The patients were divided into 2 groups(n=60 each)using a random number table method:Ⅳ infu-sion of low-dose dexmedetomidine combined with scalp nerve block group(Dex+SNB group)and scalp nerve block group(SNB group).Dexmedetomidine 0.2 μg·kg-1·h-1(in 50 ml of normal saline)was in-travenously infused over 24 h in Dex+SNB group,while the equal volume of normal saline was given instead in SNB group.The electronic intravenous analgesia pump was routinely used after operation,the solution contained sufentanil 2 μg/kg+ondansetron 0.3 mg/kg in 100 ml of normal saline,and the pump was set up to deliver a 2 ml bolus dose with a 30-min lockout interval and no background infusion.The FLACC scale was used to evaluate the level of pain.The FLACC scale was used to evaluate the degree of pain.When the FLACC pain scale score ≥ 4,the analgesia pump was first pressed by the nursing staff in the post-anesthe-sia care unit,intensive care unit or ward.If that did not work,oral acetaminophen was given at a dose of 15 mg/kg for rescue analgesia.The consumption of sufentanil was recorded within 1,2,4,18,24 and 48 h af-ter operation.The FLACC score,Richmond agitation-sedation score(RASS score)and Cornell pediatric de-lirium score(CAPD score)were assessed at 1,2,4,18,24 and 48 h after operation.The occurrence of moderate or severe pain(pain FLACC score ≥ 4),rescue analgesia,excessive sedation(RASS score ≤-3),agitation(RASS score≥2),delirium(CAPD score＞9)and poor sleep quality(sleep quality score≤2)within 48 h after operation were recorded.The occurrence of drug-and surgery-related adverse re-actions within 48 h after operation was recorded.Results Fifty-six children were ultimately included in SNB group,and 55 children in Dex+SNB group.Compared with SNB group,the consumption of sufentanil was significantly reduced within 2,4,18 and 24 h postoperatively,the FLACC score for pain was decreased at 18 h postoperatively,the incidence of poor sleep quality was decreased on postoperative day 1(P＜0.05),and no significant change was found in the incidence of moderate or severe pain,excessive sedation,agitation,delirium and adverse reactions after surgery in Dex+SNB group(P＞0.05).Conclusions Com-pared with scalp nerve block alone,combination of Ⅳ infusion of low-dose dexmedetomidine and scalp nerve block can reduce the amount of opioids and improve sleep quality when used for postoperative analgesia in preschool children undergoing craniotomy.
基金项目
北京市东城区优秀人才培养资助项目(2019DCT-M-17)
Beijing Municipal Dongcheng District Hospital Scientific Research Training Program(PX2017011)
NETL
NSTL
万方数据