小儿尿道下裂术后不同镇痛方法效果观察.docVIP

小儿尿道下裂术后不同镇痛方法效果观察 　【摘要】 目的：比较吗啡复合氟哌啶静脉镇痛、吗啡复合布比卡因硬膜外镇痛及传统的镇痛方法用于小儿尿道下裂术后镇痛的效果及不良反应。方法：60例尿道下裂患儿，随机分为吗啡复合氟哌啶静脉镇痛组（A组，n=20）、吗啡复合布比卡因硬膜外镇痛组（B组，n=20）与传统组（C 组，n=20）。A组：吗啡0.8mg／kg，氟哌利多0.05 mg／kg ，加生理盐水至100ml，术毕静脉泵入1ml/h,，一次剂量1ml，锁定时间10min。B组：术毕前30min给予硬膜外吗啡0.03 mg／kg静脉氟哌利多0.05mg／kg，术毕吗啡0.15mg/kg，加入0.125%布比卡因150ml持续泵入2ml/h,。C组按需注射度冷丁。观察术后镇痛效果、并发症等情况。结果：A、B组的VAS评分无明显差异，但明显低于C组（P＜0.01），A组、B组患儿均安静，无嗜睡和哭闹。C组10例哭闹，A组有2例出现轻度恶心呕吐，1例皮肤瘙痒，B组有1例出现轻度恶心呕吐，1例皮肤瘙痒。结论：小儿尿道下裂术后吗啡复合氟哌啶静脉镇痛、吗啡复合布比卡因硬膜外镇痛均可有效减轻尿道下裂患儿术后的疼痛，二者效果相当且并发症少，明显优于传统镇痛方法。 【关键词】 尿道下裂 镇痛 硬膜外腔 吗啡 　　Observation on Different Analgesia Methods After Hypospadias Surgery in Pediatric Patients 　　　　Abstract:Objective:To study the analgesia and side effects among morphine combined droperidol, morphine combined bupivacaine in extradural space block and traditional methods after hypospadias surgery in pediatric patients.Method:60 cases of pediatric hypospadias were randomized into three groups,group A:morphine combined droperidol, morphine 0.8mg/kg，droperidol 0.05 mg/kg ，added NS to 100ml，pumped in 1ml/h，single dose 1ml，lock time 10min;group B: morphine combined bupivacaine, extradural space infused morphine 0.03 mg/kg before operation,morphine 0.15mg/kg added 0.125%bupivacaine 150ml 2ml/h pumped in;group C:injected dolantin if necessary.each group consisting of 20 cases.The analgesia and side effects were observed after operation.Result:The VAS score had no difference between group A and group B,but that in group C was higher(Plt;0.01).2 cases had nausea and vomiting and 1 case had skin itch in group A, 1 case had nausea and vomiting and 1 case had skin itch in group B,10 cases made a noise in group C.Conclusion: Morphine combined droperidol and morphine combined bupivacaine in extradural analgesia are precede to traditional methods.And both have less complication. 　　Key words: Hypospadias； Analgesia； Extradural space； Morphine 　　小儿术后镇痛越来越受到重视，由于吗啡的不良反应较多，尤其呼吸抑制限制小儿术后镇痛的应用，本文对尿道下裂患儿给予PCIA，PCEA，并与传统的肌注镇痛药镇痛方法进行比较。 　　1 资料与方法 　　1．