分析在小兒手術中應用硬膜外麻醉復合超前多模式鎮痛的效果影響

賈淑芬

摘要：目的 對小兒手術選擇硬膜外麻醉聯合超前多模式鎮痛方案的應用效果進行觀察分析。方法 于本院接受下肢及會陰位置手術治療患兒中篩選70例納入研究。依據麻醉方案不同進行分組，手術時僅接受硬膜外麻醉納入對照組，同時聯合實施超前多模式陣痛納入觀察者，對比兩組陣痛效果及不良反應。結果 觀察組術后4h、8h疼痛評分均低于對照組，麻醉完善率高于對照組（P<0.05）;兩組患兒各時間節點各項生命體征指標平穩且無明顯差異（P>0.05）;兩組手術及麻醉過程中均未發生不良反應。結論 選擇硬膜外麻醉聯合超前多模式鎮痛方案，術中可獲得更加理想麻醉效果，顯著提升術后陣痛效果，且安全性理想，值得推廣應用于臨床中。

關鍵詞：小兒手術;硬膜外麻醉;超前多模式鎮痛;應用效果

[Abstract] Objective To observe and analyze the application effect of epidural anesthesia combined with advanced multimodal analgesia in pediatric surgery. Methods a total of 70 children with lower extremity and perineal surgery were enrolled in the study. The patients were divided into two groups according to different anesthesia schemes. The patients who only received epidural anesthesia during operation were included in the control group，and the patients who combined with advanced multimodal labor pain were included in the observation group. The labor pain effect and adverse reactions of the two groups were compared. Results the pain scores at 4H and 8h after operation in the observation group were lower than those in the control group，and the improvement rate of anesthesia in the observation group was higher than that in the control group（P < 0.05）;The vital signs of the two groups were stable at each time point，and there was no significant difference（P > 0.05）;There were no adverse reactions during operation and anesthesia in the two groups. Conclusion epidural anesthesia combined with advanced multimodal analgesia can obtain more ideal anesthesia effect，significantly improve the effect of postoperative labor pain，and the safety is ideal，which is worthy of clinical application.

[Key words] pediatric surgery;Epidural anesthesia;Preemptive multimodal analgesia;Application effect

與成人相比，兒童由于器官、組織以及身體機能都未發育完善，在治療過程中更容易發生麻醉不良事件【1】，選擇合適的麻醉方案是確保手術效果的關鍵。連續硬膜外麻醉有創且會誘發出血，且有較高幾率發生阻滯不全，手術過程中無法確保血流動力學穩定并確切降低應激反應【2-3】。為了進一步提升小兒手術麻醉效果及安全性，本次研究對接受下肢及會陰位置手術治療患兒選擇硬膜外麻醉聯合超前多模式鎮痛方案，重點觀察其應用效果及安全性。報道如下。

1 一般資料與方法

1.1 一般資料

于本院接受下肢及會陰位置手術治療患兒中篩選70例納入研究，收集時間為2019年10月-2020年12月，依據麻醉方案不同進行分組。觀察組，男20例，女15例，年齡8-11歲，均值（9.3±1.2）歲。對照組，男23例，女12例，年齡8-12歲，均值（9.7±1.6）歲。患兒基線資料比較，無統計學差異（P>0.05）。

1.2 方法

兩組術前均規范完成訪視，對患兒和家長進行必要心理疏導，詳細了解患兒家族病史及過敏史，明確近期身體狀態，確認各項檢查結果，評價是否存在麻醉禁忌癥。要求麻醉前4h禁飲、6h禁食。做好術前處置及準備。

對照組接受硬膜外麻醉：硬膜外穿刺，鹽酸普魯卡因皮膚浸潤麻醉，成功后一次性注入利多卡因、腎上腺素（1：200000）、布比卡因（計量根據患兒體重確定）。

觀察者硬膜外麻醉聯合超前多模式鎮痛方案：丙泊酚麻醉鎮靜起效后實施硬膜外穿刺，后鹽酸普魯卡因皮膚浸潤麻醉，一次性注入利多卡因、腎上腺素（1：200000）、布比卡因（計量根據患兒體重確定）。

1.3? 觀察指標