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目的:观察地塞米松联合罗哌卡因局部浸润用于小儿扁桃体等离子切除术后镇痛的效果。方法:择期全麻下行扁桃体切除术的患儿90例,采取随机数字法分为3组,于全麻气管插管后扁桃体周围局部注射罗哌卡因(A组,n=30),或地塞米松和罗哌卡因混合液(B组,n=30),对照组采用生理盐水(C组,n=30)。记录术后30min,1h,2h,4h,8h,12h,24h时东安大略儿童医院改良疼痛评分(mCHEOPS),评分高于5时静脉给予芬太尼1μg/kg。记录术后各组需补救镇痛药的患儿例数,观察不良反应,包括恶心呕吐、呼吸抑制、创面出血。结果:A组、B组在术后各观察时点mCHEOPS疼痛评分均低于对照组(P<0.05)。A组与B组比较,疼痛评分在术后30min、1h、2h时无显著性差异(P>0.05),但在4-24h各观察时点,B组较A组疼痛评分低(P<0.05)。A组、B组需补救镇痛药的患儿明显少于对照组,与A组比较,B组需要补救镇痛药的患儿显著减少(P<0.05)。A组、B组较对照组恶心呕吐的发生率低(P<0.05),两组之间无显著性差异(P>0.05)。3组均未发现呼吸抑制及创面出血。结论:地塞米松联合罗哌卡因扁桃体周围局部浸润用于小儿扁桃体等离子切除可有效减轻术后24h疼痛,且不增加不良反应。
Objective: To observe the effect of dexamethasone combined with local infiltration of ropivacaine on post-operative analgesia after tonsillectomy in children. Methods: Ninety children undergoing tonsillectomy under elective general anesthesia were randomly divided into three groups: local injection of ropivacaine (group A, n = 30) around the tonsil after intubation; or The mixture of dexamethasone and ropivacaine (group B, n = 30) was given normal saline (group C, n = 30). The score of mCHEOPS was recorded at the Children’s Hospital of Ontario East Ontario at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 12 hours and 24 hours after operation. Fentanyl 1 μg / kg was given intravenously when the score was higher than 5 hours. The number of children requiring analgesics to be remedied in each group was recorded. Adverse reactions were observed, including nausea and vomiting, respiratory depression, and wound bleeding. Results: The pain scores of mCHEOPS in group A and group B after operation were all lower than those in control group (P <0.05). There was no significant difference in pain score between group A and group B at 30min, 1h and 2h after operation (P> 0.05), but at 4-24h, the score of pain in group B was lower than that of group A (P <0.05) ). In group A and group B, the number of children requiring analgesic remedy was significantly lower than that in control group. Compared with group A, the number of children requiring analgesic remedy in group B was significantly decreased (P <0.05). The incidence of nausea and vomiting in group A and group B was lower than that in control group (P <0.05). There was no significant difference between the two groups (P> 0.05). No respiratory depression and wound bleeding were found in the three groups. Conclusion: Local infiltration of dexamethasone combined with ropivacaine for the tonsil plasma resection in children can effectively reduce the pain after 24h, and does not increase adverse reactions.