目的 探讨小儿发育性髋脱位矫正术超声引导下骶管阻滞效果。方法 选取2016-06至2018-06在北京积水潭医院进行小儿发育性髋脱位矫正术患者70例,随机分为试验组和对照组,每组35例。试验组予以超声引导定位骶管阻滞麻醉,对照组常规使用0.2％罗哌卡因硬膜外阻滞。记录两组患儿的穿刺情况;记录两组患儿的罗哌卡因用量、切皮前后血压(BP)及心率(HR)变化;记录术中芬太尼用量;记录术后2、4、6、12、24 h及48 h的患儿疼痛FLACC评分及患儿首次使用乙酰氨基酚时间;记录患儿睡眠障碍镇静评分(Ramsay评分),评价患儿术后12 h的镇静情况;记录患儿术后并发症情况。结果 试验组的穿针调整次数显著少于对照组(P<0.05);而试验组的穿刺时间[(13.42±2.50)min]长于对照组[(5.73±2.12)min],差异有统计学意义(P<0.05);试验组患儿的罗哌卡因用量高于对照组(P<0.05);试验组患儿术后首次觅求对乙酰氨基酚时间[(19.6±3.2)h]明显晚于对照组[(11.4±4.1)h],差异有统计学意义(P<0.05)。术后12 h,试验组的FLACC评分(1.6±0.9)明显低于对照组(4.3±1.5),差异有统计学意义(P<0.05)。但试验组术后12 h的Ramsay评分要高于对照组(P<0.05)。结论 在小儿DDH矫正术采用超声引导下骶管阻滞可提供术后24 h有效镇痛,值得临床推广。

Objective To investigate the clinical effect of sacral canal block guided by ultrasound in the correction of developmental dislocation of the hip in children.Methods Seventy cases of children under developmental hip dislocation correction in our hospital between June 2016 and June 2018 were selected and randomly divided into two groups, with 35 cases in each. The experimental group underwent sacral canal block under ultrasound guidance while the control group received lumbar epidural block using 0.2% ropivacaine. The puncture status of patients in both groups was recorded, so were the changes of ropivacaine dosage, BP and HR. Intraoperative fentanyl dosage was recorded. The pain FLACC score at 2, 4, 6, 12, 24 h and 48h after surgery and the time acetaminophen was used for the first time were recorded. The sleep disturbance sedation score (Ramsay score) of the children was recorded to evaluate the sedation of the children 12 hours after surgery. Postoperative complications were also recorded.Results The number of times needle penetration was adjusted in the experimental group was significantly smaller than that in the control group (P<0.05).The puncture time of the experimental group (13.42±2.50) min was longer than that of the control group (5.73±2.12) min (P<0.05). The dosage of ropivacaine in the experimental group was higher than that in the control group (P<0.05). There was no significant difference in the intraoperative fentanyl dosage between the two groups.In the experimental group, the time acetaminophen was used for the first time after surgery (19.6±3.2) h was significantly later than in the control group (11.4±4.1) h (P<0.05). Twelve hours after surgery, the FLACC score of the experimental group (1.6±0.9) was significantly lower than that of the control group (4.3±1.5), P<0.05.However, Ramsay score of the experimental group was higher than that of the control group 12 h after surgery (P<0.05).Conclusions Sacral canal block guided by ultrasound in pediatric DDH correction can provide effective analgesia 24h after surgery, which is worthy of wider application.