【摘要】 目的：分析达克罗宁联合右美托咪定及酮咯酸氨丁三醇对小儿隐匿性阴茎术后镇痛和应激的影响。方法：选取2022年6—9月于九江市第一人民医院择期行气管插管全麻下隐匿型阴茎手术的120例患儿为研究对象，采用随机数字表法分为A组（酮咯酸氨丁三醇+达克罗宁胶浆镇痛）、B组（右美托咪定+达克罗宁胶浆镇痛）、C组（右美托咪定+酮咯酸氨丁三醇+达克罗宁胶浆镇痛），每组40例，所有患儿均为静吸复合麻醉。记录三组术中血流动力学指标[手术开始即刻（T₀）、手术开始30 min（T₁）、苏醒时（T₂）的心率（HR）、平均动脉压（MAP）]及术中丙泊酚、芬太尼、瑞芬太尼使用剂量；比较三组术后1、24、48 h的疼痛[加拿大东安大略儿童医院镇痛量表（CHEOPS）评分]、镇静[麻醉苏醒期躁动评分系统（Watcha）评分]及实验室指标[皮质醇（Cor）、肾上腺素（E）、血糖（Glu）]；评估三组用药安全性。结果：三组HR、MAP在术中呈先降低后升高趋势（P<0.05）,C组T₁、T₂时HR、MAP均低于A组与B组（P<0.05），但三组组间与时间并无明显交互效应（P>0.05）。C组术中丙泊酚使用剂量明显低于A组与B组（P<0.05）；三组术中芬太尼、瑞芬太尼使用剂量比较，差异均无统计学意义（P>0.05）。三组术后CHEOPS、Watcha评分及Cor、E水平组间与时间均存在交互效应（P<0.05）；三组术后24 h CHEOPS、Watcha评分均高于术后1 h，术后48 h均低于术后24 h（P<0.05）,C组术后1 h及术后24 h CHEOPS、Watcha评分均低于A组与B组（P<0.05）。三组术后24、48 h Cor、E水平均低于术后1 h，术后48 h均低于术后24 h（P<0.05）,C组术后1、24 h Cor、E水平均低于A组与B组（P<0.05）。三组Glu水平在术后呈下降趋势（P<0.05）,C组术后1、24 h Glu水平均低于A组与B组（P<0.05），但组间与时间并无明显交互效应（P>0.05）。三组不良反应有低血压、恶心及嗜睡反应，总发生率分别为12.50%、12.50%、5.00%，组间差异无统计学意义（P>0.05）。结论：小儿隐匿性阴茎术采用达克罗宁联合右美托咪定及酮咯酸氨丁三醇的术后镇痛效果较好，可减轻应激反应，减少丙泊酚使用剂量，减少患儿术后躁动。更多还原

【Abstract】 Objective:To analyze the effects of Dyclonine combined with Dexmedetomidine and Ketorolac Tromethamine on analgesia and stress after concealed penile surgery in children.Method:A total of 120 children who underwent elective tracheal intubation and concealed penis surgery under general anesthesia in Jiujiang NO.1 People’s Hospital from June to September 2022 were selected as research subjects.The children were divided into group A （Ketorolac Tromethamine+Dyclonine Mucilage for analgesia）,group B （Dexmedetomidine+Dyclonine Mucilage for analgesia） and group C （Dexmedetomidine+Ketorolac Tromethamine+Dyclonine Mucilage for analgesia） by the random number table method,with 40 cases in each group.All children were given intravenous inhalation anesthesia.Intraoperative hemodynamics[heart rate （HR） and mean arterial pressure （MAP）at the beginning of surgery （T₀）,at 30 min after the beginning of surgery （T₁） and at the time of recovery （T₂）]and intraoperative doses of Propofol,Fentanyl and Remifentanil were recorded among the three groups.The differences in pain[Children’s Hospital of Eastern Ontario pain scale （CHEOPS） score],sedation[anesthesia recovery agitation scoring system （Watcha） score]and laboratory indicators[cortisol （Cor）,epinephrine （E）,blood glucose （Glu）]were compared among the three groups at 1,24,48 h after surgery,and the drug safety in the three groups was evaluated.Result:The HR and MAP in the three groups were decreased first and then increased （P<0.05）,and the HR and MAP in group C were lower than those in group A and group B group at T₁ and T₂ （P<0.05）,but there were no significant interaction effects of between-group and time-point （P>0.05）.The intraoperative dose of Propofol in group C was significantly less than those in group A and group B （P<0.05）.There were no statistical differences in intraoperative doses of Fentanyl and Remifentanil among the three groups （P>0.05）.CHEOPS,Watcha scores and levels of Cor and E in the three groups had significant interaction effects （P<0.05）.CHEOPS score and Watcha scores in the three groups at 24 h after surgery were higher than those at 1 h after surgery,and the scores at 48 h after surgery were lower than those at 24 h after surgery （P<0.05）.CHEOPS and Watcha scores at 1,24 h after surgery in group C were lower than those in group A and group B （P<0.05）.The levels of Cor and E in the three groups at 24,48 h after surgery were lower than those at 1 h after surgery,and those at 48 h after surgery were lower than those at 24 h after surgery （P<0.05）.The levels of Cor and E in group C at 1,24 h after surgery were lower than those in group A and group B （P<0.05）.The Glu levels in the three groups showed a decreasing trend after surgery （P<0.05）,and the Glu levels in group C were lower than those in group A and group B at 1,24 h after surgery （P<0.05）,but there was no significant interaction effect of between-group and time-point （P>0.05）.The adverse reactions included hypotension,vomiting and drowsiness in the three groups,and the total incidence rates were 12.50%,12.50%and5.00%respectively,with no statistical significance between the groups （P>0.05）.Conclusion:The postoperative analgesic effect of Dyclonine combined with Dexmedetomidine and Ketorolac Tromethamine for concealed penis surgery in children is better,which can reduce stress response,reduce the dosage of Propofol and reduce postoperative agitation in children.更多还原