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本文引用的文献

1
Caudal epidural sufentanil and bupivacaine decreases stress response in paediatric cardiac surgery.
Ann Card Anaesth. 2009 Jan-Jun;12(1):27-33. doi: 10.4103/0971-9784.45010.
2
Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children.在骶管阻滞中，将舒芬太尼添加到布比卡因中对儿童应激反应的影响。
Pediatr Int. 2007 Dec;49(6):928-32. doi: 10.1111/j.1442-200X.2007.02479.x.
3
Caudal anesthesia in pediatric cardiac surgery: does it affect outcome?小儿心脏手术中的骶管麻醉：它会影响手术结果吗？
J Cardiothorac Vasc Anesth. 2005 Dec;19(6):734-8. doi: 10.1053/j.jvca.2005.01.041.
4
A randomized trial of caudal block with bupivacaine 4 mg x kg-1 (1.8 ml x kg-1) plus morphine (150 microg x kg-1) vs general anaesthesia with fentanyl for cardiac surgery.一项关于布比卡因4 mg·kg⁻¹（1.8 ml·kg⁻¹）加吗啡（150 μg·kg⁻¹）骶管阻滞与芬太尼全身麻醉用于心脏手术的随机试验。
Paediatr Anaesth. 2003 May;13(4):311-7. doi: 10.1046/j.1460-9592.2003.01063.x.
5
Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome.小儿心脏手术期间硬膜外给予舒芬太尼：对代谢反应和术后结局的影响
Paediatr Anaesth. 2000;10(6):609-17. doi: 10.1111/j.1460-9592.2000.00557.x.
6
A retrospective examination of regional plus general anesthesia in children undergoing open heart surgery.
Anesth Analg. 2000 May;90(5):1020-4. doi: 10.1097/00000539-200005000-00004.
7
A report of two hundred twenty cases of regional anesthesia in pediatric cardiac surgery.小儿心脏手术中220例区域麻醉报告。
Anesth Analg. 2000 May;90(5):1014-9. doi: 10.1097/00000539-200005000-00002.
8
Epidural administered buprenorphine in the perioperative period.围手术期硬膜外给予丁丙诺啡。
Can J Anaesth. 1996 Sep;43(9):907-13. doi: 10.1007/BF03011803.
9
Post-operative pain relief in children following caudal bupivacaine and buprenorphine--a comparative study.儿童尾骶部注射布比卡因和丁丙诺啡术后镇痛的比较研究
J Postgrad Med. 1994 Apr-Jun;40(2):61-4.
10
Comparison of caudal morphine and buprenorphine for post-operative analgesia in children.
Eur J Anaesthesiol. 1993 Jul;10(4):309-12.

在接受心脏直视手术的儿科患者中，静脉镇痛全身麻醉与骶管镇痛全身麻醉的血流动力学反应及术后疼痛评分比较。

Comparison of hemodynamic response and postoperative pain score between general anaesthesia with intravenous analgesia versus general anesthesia with caudal analgesia in pediatric patients undergoing open-heart surgery.

作者信息

Samantaray Dharma Jivan, Trehan Meena, Chowdhry Vivek, Reedy Satish

机构信息

Department of Cardiac Anaesthesiology, Care Hospital, Bhubaneswar, Odisha, India.

Department of Anaesthesiology, Apollo Hospital, Hyderabad, Telangana, India.

出版信息

Ann Card Anaesth. 2019 Jan-Mar;22(1):35-40. doi: 10.4103/aca.ACA_215_17.

DOI:10.4103/aca.ACA_215_17
PMID:30648677
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6350425/
Abstract

CONTEXT

Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery.

AIMS

This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures.

SETTINGS AND DESIGN

We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique.

SUBJECTS AND METHODS

After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution.

STATISTICAL ANALYSIS

ANOVA, two-way ANOVA, and Student's test.

RESULTS

The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004).

CONCLUSIONS

Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.

摘要

背景

区域麻醉可能减轻与心胸外科手术相关的不良生理应激反应。在本研究中，比较了接受全身麻醉（GA）联合骶管硬膜外镇痛与GA联合静脉镇痛的小儿心脏直视手术患者在手术刺激不同时间的血流动力学应激反应。

目的

本研究旨在比较小儿心脏手术患者在手术刺激不同时间的血流动力学反应及术后疼痛评分。

设置与设计

我们设计了一项前瞻性随机对照试验，以研究I组和II组之间的血流动力学效应。采用密封信封技术将50例患者随机均分为I组（GA + 骶管硬膜外）和II组（GA + 静脉镇痛）。

研究对象与方法

获得机构伦理委员会批准后，本前瞻性研究在我院50例年龄在1至12岁、美国麻醉医师协会分级为II级和III级的小儿心脏手术患者中进行。

统计分析

方差分析、双向方差分析和学生检验。

结果

比较了I组和II组在不同时间间隔的心率、收缩压、舒张压和平均血压变化。发现II组在皮肤切开时和皮肤切开后2分钟的变化明显高于I组。比较了两组之间的疼痛评分，发现I组（2.5±1.2）明显低于II组（4.6±1.7），P =（0.004）。

结论

GA联合骶管镇痛（I组）在血流动力学控制方面更好，且在苏醒后24小时内术后疼痛缓解明显更好。