Effects of multimodal analgesia on inflammatory cytokines and rapid rehabilitation after surgery in 3 -6 months infant with Hirschprung＇s disease / 中华实用儿科临床杂志

ABSTRACT

Objective To study the effects of patient-controlled intravenous analgesia( PCIA)with Dexme-detomidine,Ropivacaine by local incision infiltration and combined analgesia on inflammatory factors and rapid rehabili-tation in infants aged 3-6 months after radical resection of megacolon. Methods From June 2016 to March 2018,90 infants aged 3-6 months underwent radical resection of megacolon in Henan Provincial Children＇s Hospital as the sub-jects. According to the postoperative analgesia mode applied to the children,they were divided into Dexmedetomidine group,Ropivacaine group and combined group( Dexmedetomidine PCIA combined with local infiltration of Ropiva-caine),30 cases in each group. The serum levels of interleukin( IL)-6 and IL-10 were measured and recorded 2 hours before operation and 24 hours after operation,and the analgesic scores of 4,8,12 and 24 hours after operation were recorded. The rapid recovery index of each group,standard and the number of complications were compared. Results Compared with 2 hours before operation,the serum levels of IL-6 in the Dexmedetomidine group,Ropiva-caine group and combined group[(24. 61 ± 1. 44)ng/L υs.(13. 84 ± 0. 65)ng/L,(26. 39 ± 1. 29)ng/L υs.(13. 85 ± 0. 67)ng/L,(20. 58 ± 2. 06)ng/L υs.(13. 87 ± 0. 63)ng/L],IL-10[(27. 63 ± 1. 52)ng/L υs.(15. 79 ± 1. 48) ng/L,(28. 29 ± 2. 34)ng/L υs.(15. 41 ± 1. 37)ng/L,(23. 21 ± 2. 71)ng/L υs.(15. 47 ± 1. 52)ng/L]were signifi-cantly higher(all P<0. 05),while the levels of IL-6,IL-10 in combined group were lower than those in Dexmedeto-midine group and Ropivacaine group(ta =9. 172,9. 835;tb =10. 221,11. 034,all P<0. 05). At 4 h,8 h,12 h,24 h after operation. The analgesic scores in combined group were(1. 89 ± 0. 23)scores,(1. 87 ± 0. 15)scores,(1. 95 ± 0. 17)scores,(2. 08 ± 0. 18)scores,those of dexmedetomidine group were(2. 06 ± 0. 24)scores,(2. 08 ± 0. 18) scores,(2. 76 ± 0. 29)scores,(2. 55 ± 0. 31)scores,those of Ropivacaine group were(2. 10 ± 0. 26)scores,(2. 15 ± 0. 26)scores,(2. 32 ± 0. 19)scores,(3. 00 ± 0. 28)scores,and the analgesic scores in combined group were signifi-cantly lower than those in Dexmedetomidine group and Ropivacaine group( ta =8. 526,9. 364,10. 287,9. 521;tb =8. 729,9. 514,11. 037,9. 184,all P<0. 05). In comparison with the first exhaust time,anal extubation time,hospitali-zation days,hospitalization expenses and antibiotic use time in the three groups,it was found that combined group was significantly better than Dexmedetomidine group and Ropivacaine group(ta =8. 315,8. 294,7. 883,9. 261,10. 487;tb =8. 582,8. 329,7. 916,9. 348,10. 862,all P<0. 05). The incidence of complications in the combined group,Dexme-detomidine group,and Ropivacaine group were not significantly different in 3 groups( χ2 = 0. 577,P = 0. 749 ). Conclusions The continuous anesthesia of Dexmedetomidine combined with local infiltration of Ropivacaine incision can alleviate the postoperative inflammatory reaction and promote the rapid recovery of children.