賈淑芬

摘要：目的 對(duì)小兒手術(shù)選擇硬膜外麻醉聯(lián)合超前多模式鎮(zhèn)痛方案的應(yīng)用效果進(jìn)行觀察分析。方法 于本院接受下肢及會(huì)陰位置手術(shù)治療患兒中篩選70例納入研究。依據(jù)麻醉方案不同進(jìn)行分組，手術(shù)時(shí)僅接受硬膜外麻醉納入對(duì)照組，同時(shí)聯(lián)合實(shí)施超前多模式陣痛納入觀察者，對(duì)比兩組陣痛效果及不良反應(yīng)。結(jié)果 觀察組術(shù)后4h、8h疼痛評(píng)分均低于對(duì)照組，麻醉完善率高于對(duì)照組（P<0.05）;兩組患兒各時(shí)間節(jié)點(diǎn)各項(xiàng)生命體征指標(biāo)平穩(wěn)且無(wú)明顯差異（P>0.05）;兩組手術(shù)及麻醉過(guò)程中均未發(fā)生不良反應(yīng)。結(jié)論 選擇硬膜外麻醉聯(lián)合超前多模式鎮(zhèn)痛方案，術(shù)中可獲得更加理想麻醉效果，顯著提升術(shù)后陣痛效果，且安全性理想，值得推廣應(yīng)用于臨床中。

關(guān)鍵詞：小兒手術(shù);硬膜外麻醉;超前多模式鎮(zhèn)痛;應(yīng)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(jī)能都未發(fā)育完善，在治療過(guò)程中更容易發(fā)生麻醉不良事件【1】，選擇合適的麻醉方案是確保手術(shù)效果的關(guān)鍵。連續(xù)硬膜外麻醉有創(chuàng)且會(huì)誘發(fā)出血，且有較高幾率發(fā)生阻滯不全，手術(shù)過(guò)程中無(wú)法確保血流動(dòng)力學(xué)穩(wěn)定并確切降低應(yīng)激反應(yīng)【2-3】。為了進(jìn)一步提升小兒手術(shù)麻醉效果及安全性，本次研究對(duì)接受下肢及會(huì)陰位置手術(shù)治療患兒選擇硬膜外麻醉聯(lián)合超前多模式鎮(zhèn)痛方案，重點(diǎn)觀察其應(yīng)用效果及安全性。報(bào)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(huì)陰位置手術(shù)治療患兒中篩選70例納入研究，收集時(shí)間為2019年10月-2020年12月，依據(jù)麻醉方案不同進(jìn)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(duì)照組，男23例，女12例，年齡8-12歲，均值（9.7±1.6）歲?；純夯€資料比較，無(wú)統(tǒng)計(jì)學(xué)差異（P>0.05）。

1.2 方法

兩組術(shù)前均規(guī)范完成訪視，對(duì)患兒和家長(zhǎng)進(jìn)行必要心理疏導(dǎo)，詳細(xì)了解患兒家族病史及過(guò)敏史，明確近期身體狀態(tài)，確認(rèn)各項(xiàng)檢查結(jié)果，評(píng)價(jià)是否存在麻醉禁忌癥。要求麻醉前4h禁飲、6h禁食。做好術(shù)前處置及準(zhǔn)備。

對(duì)照組接受硬膜外麻醉：硬膜外穿刺，鹽酸普魯卡因皮膚浸潤(rùn)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(jì)量根據(jù)患兒體重確定）。

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

1.3? 觀察指標(biāo)