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| 盐酸达克罗宁胶浆局部涂抹在患儿包皮环扎术中的麻醉效果 |
| Anesthetic efficacy of topical dyclonine hydrochloride mucilage for preputial encircling in children |
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| DOI：10.12089/jca.2019.02.011 |
| 中文关键词: 盐酸达克罗宁胶浆 表面麻醉 患儿 包皮环扎术 苏醒期躁动 |
| 英文关键词: Dyclonine hydrochloride mucilage Superficial anesthesia Child Preputial Encircling Emergence agitation |
| 基金项目: |
| 作者 | 单位 | E-mail | | 李强 | 330006,南昌市,江西省儿童医院麻醉科 | | | 胡华琨 | 330006,南昌市,江西省儿童医院麻醉科 | | | 肖煜 | 330006,南昌市,江西省儿童医院麻醉科 | | | 沈世晖 | 330006,南昌市,江西省儿童医院麻醉科 | | | 傅欢 | 330006,南昌市,江西省儿童医院麻醉科 | | | 叶玲玲 | 南昌大学第一附属医院麻醉科 | 453043316@qq.com |
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| 中文摘要: |
目的 探讨盐酸达克罗宁胶浆局部涂抹在患儿包皮环扎术中的麻醉效果。
方法 选择拟行包皮环扎术的患儿60例，包皮过长13例，包茎47例，年龄4～12岁，体重14～38 kg，ASA Ⅰ或Ⅱ级，随机分为两组：达克罗宁组（D组）和对照组（C组），每组30例。D组入室前30 min在家长配合下，将1%盐酸达克罗宁胶浆均匀涂抹于包皮过长患儿的阴茎前2/3皮肤、龟头及冠状沟;对包茎患儿，先均匀涂抹阴茎前2/3皮肤，然后用18号直式留置针的外套管插入冠状沟附近，接注射器注入1%盐酸达克罗宁胶浆，并反复挤捏龟头及冠状沟数次，达克罗宁胶浆总用量0.2～0.3 ml/kg。C组于相同时点采用相同方法涂抹等量生理盐水。两组患儿入室后都采用氯胺酮复合丙泊酚全麻。观察并记录术中体动反应的发生情况;记录麻醉诱导前（T0）、手术开始时（T1）、暴露冠状沟时（T2）、扎线时（T3）、剪除多余包皮时（T4）的HR和MAP;记录丙泊酚和氯胺酮用量;记录苏醒时间和苏醒期躁动的发生情况。
结果 T3—T4时D组HR明显慢于，MAP明显低于C组(P<0.05)。D组术中体动反应发生率明显低于C组（P<0.05），丙泊酚和氯胺酮用量明显少于C组（P<0.05），苏醒时间明显短于C组（P<0.05），苏醒期躁动发生率明显低于C组(P<0.05)。
结论 盐酸达克罗宁胶浆局部涂抹表面麻醉可有效降低全麻下包皮环扎术中患儿体动反应发生率，减轻循环波动，节减全麻药用量，缩短苏醒时间，减少苏醒期躁动。 |
| 英文摘要: |
Ojective To investigate the anesthetic efficacy of topical dyclonine hydrochloride mucilage for preputial encircling in children.
Methods Sixty children under preputial encircling, 13 patients with redundant prepuce, 47 patients with phimosis, aged 4 - 12 years, weighing 14 - 38 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups with 30 cases each: dyclonine group (group D) and control group (group C). Children with redundant prepuce in group D were smeared evenly 1% dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, glans and coronary sulcus by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. Children with phimosis in group D were smeared evenly 1% dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, and then the tube was inserted near the coronary sulcus with the 18# straight indwelling needle. The syringe was injected into the 1% dyclonine hydrochloride mucilage, and the glans and the coronary sulcus were squeezed repeatedly several times by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. The dosage of dyclonine hydrochloride mucilage for each child was 0.2 - 0.3 ml/kg. Children in group C were smeared evenly isodose normal saline at the same time. All the children were treated with ketamine and propofol anesthesia after entering. The occurrence of intraoperative body reaction were observed and recorded, HR and MAP were recorded before anaesthesia induction (T0), at the beginning of surgery (T1), at the time of the coronary sulcus was exposed (T2), at the time of ligating (T3), at the time of the excess foreskin was cut (T4), the dosage of ketamine and propofol were recorded, and the occurrence of postoperative recovery time and emergence agitation during recovery period were observed.
Results Body dynamic reaction rate in group D was significantly lower than that in group C (P < 0.05), HR and MAP was significantly lower than that in group C at T3 - T4 (P < 0.05), the dosage of ketamine and propofol was significantly smaller than that in group C (P < 0.05), the recovery time was significantly shorter than that in group C (P < 0.05), the incidence of emergence agitation was significantly decreased compared with group C (P < 0.05).
Conclusion Topical dyclonine hydrochloride mucilage can effectively decrease body movement, lessen cyclic fluctuation, economize general anesthetics, shorten recovery time, reduce emergence agitation in children undergoing preputial encircling. |
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