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摘要：
目的 观察多模式镇痛应用于患儿电子耳蜗置入术后的安全性及有效性。 方法 选择行电子耳蜗置入术的患儿84例，年龄1~6 岁，ASA分级Ⅰ、Ⅱ级。采用随机数字表法分为3组（每组28例）：患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）组（A组），PCIA联合罗哌卡因切口浸润组（B组），PCIA、罗哌卡因切口浸润联合对乙酰氨基酚组（C组）。B组和C组患儿于麻醉诱导后手术部位消毒、铺巾，由手术医师切口局部逐层浸润0.25%罗哌卡因1 ml/kg；C组患儿于手术前15 min肛塞对乙酰氨基酚30~40 mg/kg。3组患儿均采用静吸复合全身麻醉。分别观察和记录各组患儿术后苏醒即刻（T0）、术后4 h（T1）、术后8 h（T2）、术后12 h（T3）、术后24 h（T4）、术后36 h（T5）及术后48 h（T6）心率、MAP、SpO2及PACU停留时间、不良反应发生情况，分别记录各时点的FLACC评分（Face, Legs, Activity, Cry, Consolability Scale）和Ramsay镇静评分，记录T0时苏醒期躁动（Pediatric Anesthesia Emergence Delirium, PAED）评分。 结果 C组T0、T1时心率、MAP明显低于A组、B组（P＜0.05）；3组患者各时点SpO2比较，差异无统计学意义（P＞0.05）。与A组比较，B组和C组在T0~T6时FLACC评分均明显降低（P<0.05）；与B组比较，C组在T3~T6时FLACC评分均明显降低（P<0.05）。与A组比较，B组和C组在T0、T1时Ramsay镇静评分明显升高（P<0.05），其余各时点3组Ramsay镇静评分比较差异无统计学意义（P>0.05）。与A组比较，B组和C组在T0时PAED评分明显降低（P<0.05）；3组均无过度镇静、低血压、呼吸抑制的发生；3组恶心呕吐、瘙痒的发生率比较，差异无统计学意义（P>0.05）。 结论 罗哌卡因局部浸润、肛塞对乙酰氨基酚PCIA联合用于患儿电子耳蜗置入术后可增强术后镇痛效果，降低苏醒期躁动。
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Abstract: Objective To investigate the effects of multimodal analgesia on cochlear implantation in children. Methods Eighty four child patients [1-6 years, American Society of Anesthesiologists (ASA) grade Ⅰor Ⅱ] scheduled for unilateral cochlear implantation were enrolled. They were randomly divided into three groups (n=28): a patient controlled intravenous analgesia (PCIA) group (group A), a PCIA and ropivacaine wound infiltration group (group B), and a PCIA, ropivacaine wound infiltration and paracetamol suppository group (group C). Both groups B and C received 0.25% ropivacaine (1 ml/kg) for wound infiltration after anesthesia induction. Meanwhile, group C was treated with 30-40 mg/kg paracetamol suppository 15 min before operation. Patients in all groups were given combined intravenous and inhaled anesthesia. Then, the heart rate, mean arterial pressure (MAP), oxygen saturation (SpO2) and postanesthesia care unit (PACU) stay, and adverse reactions were recorded immediately after waking (T0), 4 h after surgery (T1), 8 h after surgery (T2), 12 h after surgery (T3), 24 h after surgery (T4), 36 h after surgery (T5), and 48 h after surgery (T6). The Face, Legs, Activity, Cry and Consolability Scale (FLACC) scores and Ramsay scores were recorded at each time points above. The Pediatric Anesthesia Emergence Delirium (PAED) score was recorded at T0. Results Markedly decreased heart rate and MAP were found in group C at T0 and T1, in comparison with groups A and B (P<0.05). There were no different between the two groups in SpO2 at T0-T6(P＞0.05). Compared with group A, groups B and C showed remarkable decreases in FLACC score at T0-T6(P<0.05). Compared with group B, group C showed remarkable decreases in FLACC score at T3-T6 (P<0.05). Compared with group A, groups B and C showed obvious increases in Ramsay score at T0-T6 (P<0.05). Compared with group A, groups B and C presented significantly reduced PAED score at T0 (P<0.05). There were no significant changes in the incidence of opioid related adverse effects (P>0.05). Conclusions Multimodal analgesia including ropivacaine wound infiltration, anal plug medication of paracetamol suppository and PCIA can improve the effects of postoperative analgesia and decrease the incidence of emergence agitation.
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