摘要目的 研究右美托咪定经静脉自控镇痛( PCIA)、罗哌卡因局部切口浸润及两者联合镇痛的方法对3~6月龄婴儿巨结肠根治术术后炎性因子及快速康复的影响.方法 采用对照试验方法,选择2016年6月至2018年3月在河南省儿童医院接受巨结肠根治术3~6月龄婴儿90例作为研究对象,根据患儿的术后镇痛模式将其分为右美托咪定组、罗哌卡因组、联合组( PCIA),每组30例.分别于术前2 h、术后24 h检测并记录血清中白细胞介素(IL)-6、IL-10水平;记录手术结束时、术后4、8、12、24 h的镇痛评分;比较各组术后快速康复指标(首次排气时间、肛管拔出时间、住院天数、住院费用、抗生素使用时间)及并发症例数.结果 与术前2 h 比较,术后24 h右美托咪定组、罗哌卡因组及联合组血清IL-6 的水平[(24. 61 ± 1. 44)ng/L比(13. 84 ± 0. 65)ng/L,(26. 39 ± 1. 29)ng/L比(13. 85 ± 0. 67)ng/L,(20. 58 ± 2. 06)ng/L比(13. 87 ± 0. 63)ng/L]、IL-10水平[(27. 63 ± 1. 52)ng/L比(15. 79 ± 1. 48)ng/L,(28. 29 ± 2. 34)ng/L比(15. 41 ± 1. 37)ng/L,(23. 21 ± 2. 71)ng/L比(15. 47 ± 1. 52)ng/L]均明显升高,差异均有统计学意义(均P<0. 05),但联合组血清中IL-6、IL-10 水平均低于右美托咪定组和罗哌卡因组(ta =9. 172、9. 835,tb =10. 221、11. 034,均P<0. 05).联合组在术后4 h、8 h、12 h、24 h的疼痛评分分别为(1. 89 ± 0. 23)分、(1. 87 ± 0. 15)分、(1. 95 ± 0. 17)分、(2. 08 ± 0. 18)分,均明显低于右美托咪定组[(2. 06 ± 0. 24)分、(2. 08 ± 0. 18)分、(2. 76 ± 0. 29)分、(2. 55 ± 0. 31)分]和罗哌卡因组[(2. 10 ± 0. 26)分、(2. 15 ± 0. 26)分、(2. 32 ± 0. 19)分、(3. 00 ± 0. 28)分],组间比较差异均有统计学意义(ta =8. 526、9. 364、10. 287、9. 521;tb =8. 729、9. 514、11. 037、9. 184,均P<0. 05).对3组患儿首次排气时间、肛管拔出时间、住院天数、住院费用、抗生素使用时间各项快速康复指标比较发现,联合组明显优于右美托咪定组和罗哌卡因组(ta =8. 315、8. 294、7. 883、9. 261、10. 487;tb =8. 582、8. 329、7. 916、9. 348、10. 862,均P<0. 05);3组患儿的并发症发生率比较差异无统计学意义(χ2 =0. 577,P=0. 749).结论 右美托咪定持续静脉泵入联合罗哌卡因切口局部浸润的术后镇痛方法能够减轻患儿术后炎性反应,促进患儿快速康复.

abstractsObjective To study the effects of patient-controlled intravenous analgesia( PCIA)with Dexme-detomidine,Ropivacaine by local incision infiltration and combined analgesia on inflammatory factors and rapid rehabili-tation in infants aged 3-6 months after radical resection of megacolon. Methods From June 2016 to March 2018,90 infants aged 3-6 months underwent radical resection of megacolon in Henan Provincial Children＇s Hospital as the sub-jects. According to the postoperative analgesia mode applied to the children,they were divided into Dexmedetomidine group,Ropivacaine group and combined group( Dexmedetomidine PCIA combined with local infiltration of Ropiva-caine),30 cases in each group. The serum levels of interleukin( IL)-6 and IL-10 were measured and recorded 2 hours before operation and 24 hours after operation,and the analgesic scores of 4,8,12 and 24 hours after operation were recorded. The rapid recovery index of each group,standard and the number of complications were compared. Results Compared with 2 hours before operation,the serum levels of IL-6 in the Dexmedetomidine group,Ropiva-caine group and combined group[(24. 61 ± 1. 44)ng/L υs.(13. 84 ± 0. 65)ng/L,(26. 39 ± 1. 29)ng/L υs.(13. 85 ± 0. 67)ng/L,(20. 58 ± 2. 06)ng/L υs.(13. 87 ± 0. 63)ng/L],IL-10[(27. 63 ± 1. 52)ng/L υs.(15. 79 ± 1. 48) ng/L,(28. 29 ± 2. 34)ng/L υs.(15. 41 ± 1. 37)ng/L,(23. 21 ± 2. 71)ng/L υs.(15. 47 ± 1. 52)ng/L]were signifi-cantly higher(all P<0. 05),while the levels of IL-6,IL-10 in combined group were lower than those in Dexmedeto-midine group and Ropivacaine group(ta =9. 172,9. 835;tb =10. 221,11. 034,all P<0. 05). At 4 h,8 h,12 h,24 h after operation. The analgesic scores in combined group were(1. 89 ± 0. 23)scores,(1. 87 ± 0. 15)scores,(1. 95 ± 0. 17)scores,(2. 08 ± 0. 18)scores,those of dexmedetomidine group were(2. 06 ± 0. 24)scores,(2. 08 ± 0. 18) scores,(2. 76 ± 0. 29)scores,(2. 55 ± 0. 31)scores,those of Ropivacaine group were(2. 10 ± 0. 26)scores,(2. 15 ± 0. 26)scores,(2. 32 ± 0. 19)scores,(3. 00 ± 0. 28)scores,and the analgesic scores in combined group were signifi-cantly lower than those in Dexmedetomidine group and Ropivacaine group( ta =8. 526,9. 364,10. 287,9. 521;tb =8. 729,9. 514,11. 037,9. 184,all P<0. 05). In comparison with the first exhaust time,anal extubation time,hospitali-zation days,hospitalization expenses and antibiotic use time in the three groups,it was found that combined group was significantly better than Dexmedetomidine group and Ropivacaine group(ta =8. 315,8. 294,7. 883,9. 261,10. 487;tb =8. 582,8. 329,7. 916,9. 348,10. 862,all P<0. 05). The incidence of complications in the combined group,Dexme-detomidine group,and Ropivacaine group were not significantly different in 3 groups( χ2 = 0. 577,P = 0. 749 ). Conclusions The continuous anesthesia of Dexmedetomidine combined with local infiltration of Ropivacaine incision can alleviate the postoperative inflammatory reaction and promote the rapid recovery of children.