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目的探讨多模式镇痛复合单次硬膜外麻醉在会阴区(及下肢)手术的临床疗效和可行性。方法随机选取择期行会阴区,下肢手术的患者60例,年龄8~12岁,ASAⅠ~Ⅱ级。随机分为2组(每组30例),A:单次硬膜外复合多模式镇痛组;B组:单次硬膜外组。观察术中生命体征;术后镇痛效果及并发症的发生情况。结果术中2组呼吸的频率与幅度、血氧饱和度差异无统计学意义(P>0.01);术中、呼吸(RR)、心率(HR)、血压(BP)均平稳,吸氧条件下血氧饱和度达100%,PETCO2在正常范围,潮气量、分钟通气量无明显变化。术后各时点VAS评分,A组24 h满意率达100%,A、B组差异有统计学意义(P<0.01),B组能提供术后8 h满意镇痛。2组均无躁动、谵妄、恶心、呕吐及术后尿潴留发生,无肢体感觉异常,活动障碍,皮肤瘙痒等。结论单次硬膜外麻醉复合多模式镇痛组较单次硬膜外及骶管麻醉提供更完善的术中镇痛,更满意的肌松,术后并发症少且提供更满意的术后镇痛,更能有效降低应激反应,有利于患儿身心发育及术后康复。
Objective To investigate the clinical efficacy and feasibility of multimodal analgesia combined with single epidural anesthesia in perineal (and lower extremity) surgery. Methods A total of 60 patients (aged 8-12 years) with ASA Ⅰ ~ Ⅱ were selected randomly. Randomly divided into two groups (30 cases in each group), A: single epidural multimodal analgesia group; B group: single epidural group. Observation of intraoperative vital signs; postoperative analgesia and complications occurred. Results There were no significant differences in the frequency and amplitude of respiration between the two groups during operation (P> 0.01). Respiratory rate (RR), heart rate (HR) and blood pressure (BP) Oxygen saturation of 100%, PETCO2 in the normal range, tidal volume, minute ventilation no significant change. The VAS score at each time point after operation, the satisfaction rate of A group was 100% at 24 hours, and there was significant difference between A and B groups (P <0.01). Group B was able to provide satisfactory analgesia at 8 hours after operation. No agitation in the 2 groups, delirium, nausea, vomiting and postoperative urinary retention occurred, no limb sensory abnormalities, movement disorders, skin itching and so on. Conclusion Single epidural anesthesia combined with multimodal analgesia provides better intraoperative analgesia than single epidural and caudal anesthesia, more satisfactory muscle relaxation, fewer postoperative complications and more satisfactory postoperative Analgesic, more effective in reducing stress response, is conducive to physical and mental development of children and postoperative rehabilitation.