苏春华 徐彩萍 符永强

【摘要】 目的：研究右美托咪定聯合复方利多卡因乳膏对小儿包皮环切术术后苏醒期安全性及躁动的影响。方法：选择2017年9月-2018年9月择期全麻下行小儿包皮环切术的患儿200例，按照随机数字表法分为右美托咪定联合复方利多卡因乳膏组（DL组）、右美托咪定组（D组）、复方利多卡因乳膏组（L组）、对照组（C组），每组50例。记录四组患儿术后进入复苏室30 min内心率（HR）、呼吸频率（RR）、血氧饱和度（SpO2）、躁动发生率和回到病房后6 h内的疼痛评分、镇静评分。结果：DL组、D组与L组组内比较，患儿30 min内HR均较平稳，差异均无统计学意义（P>0.05），但DL、D组各时间点的HR均低于C组，差异均有统计学意义（P<0.05）。DL组躁动发生率为8%，D组为14%，L组为12%，均明显低于C组的44%，差异均有统计学意义（P<0.05）。返回病房2、6 h时，C组的疼痛评分均明显高于其他三组，差异均有统计学意义（P<0.05）。返回病房1、2 h时，DL组、D组与L组患儿的镇静评分均高于C组，差异均有统计学意义（P<0.05）。结论：在小儿包皮环切术围术期，右美托咪定静脉泵注联合复方利多卡因乳膏局部应用是一种安全可靠的方案，具有术后良好的镇静和镇痛效果，使患儿复苏期躁动发生率降低，明显提高了麻醉恢复室的复苏质量。

【关键词】 右美托咪定; 复方利多卡因乳膏; 小儿; 包皮环切术; 躁动

【Abstract】 Objective：To study the effect of Dexmedetomidine combined with Compound Lidocaine Ointment on the safety and agitation of waking period after pediatric circumcision.Method：200 children with elective general anesthesia underwent pediatric circumcision from September 2017 to September 2018 were selected，and they were randomly divided into Dexmedetomidine combined with Compound Lidocaine Ointment group（group DL），Dexmedetomidine group（group D），Compound Lidocaine Ointment group（group L），control group（group C），50 patients in each group.Heart rate（HR），respiration rate（RR），oxygen saturation（SpO2）and incidence of agitation were recorded within 30 min after resuscitation in the recovery room，pain scores and sedation scores were recorded within 6 h after returning to the ward.Result：HR of the children in group DL，group D and group L were all stable within 30 min，the differences were not statistically significant（P>0.05），however，HR of group DL and D at each time point were lower than those of group C，the differences were statistically significant（P<0.05）.The incidence of agitation was 8% in group DL，14% in group D，and 12% in group L，all significantly lower than 44% in group C，the differences were statistically significant（P<0.05）.After returning to the ward for 2 and 6 hours，the pain scores of group C were significantly higher than those of the other three groups，with statistically significant differences（P<0.05）.After returning to ward 1 and 2 hours，sedation scores of children in group DL，D and L were higher than that in group C，with statistically significant differences（P<0.05）.Conclusion：In the perioperative period of pediatric circumcision，the local application of Dexmedetomidine intravenous infusion combined with Compound Lidocaine Cream is a safe and reliable scheme with good postoperative sedative and analgesic effects，which reduces the incidence of restlessness in the recovery period of children and significantly improves the quality of recovery in the anesthesia recovery room.

【Key words】 Dexmedetomidine; Compound Lidocaine Ointment; Pediatric; Circumcision; RestlessnessFirst-authors address：Maternal and Child Health Hospital of Pingshan District in Shenzhen，Shenzhen 518122，China

doi：10.3969/j.issn.1674-4985.2019.17.012

包皮環切术能有效解决小儿包皮过长、包茎这类常见疾病，但是包皮环切术引起强烈的疼痛可造成患儿术后躁动发生，影响病情的预后。因此，有效的术后镇痛能在一定程度上降低躁动的发生。右美托咪定是一种高选择性α2肾上腺素能受体激动剂，张忠其等[1]研究发现术前单次给予0.5 μg/kg的右美托咪定能明显降低包皮环切术小儿术后烦躁，然而右美托咪定并无明显的镇痛作用。复方利多卡因乳膏其主要成分为丙胺卡因和利多卡因，术后局部应用能增加术后镇痛的作用，从而减少术后躁动发生[2]。然而两种药物结合应用是否能进一步降低小儿术后躁动的发生率还值得研究探讨。本研究主要采用右美托咪定联合复方利多卡因乳膏，观察其对小儿包皮环切术术后苏醒期安全性及躁动的影响，为临床小儿术后康复提供参考，现报道如下。