| 摘要: |
| 目的:探讨罗哌卡因在儿童局部浸润麻醉引起中枢毒性反应的临床表现、危险因素及处理策略。 方法:分析 1 例 8 岁男 童在接受包皮环切术,使用盐酸罗哌卡因注射液行局部浸润麻醉后 1 min 内出现全身抽搐、肌肉震颤、口吐白沫等中枢毒性反 应的病例。 采用诺氏评估量表评估不良反应(ADR)因果关系,并系统回顾相关文献。 结果:患儿在注射罗哌卡因后迅速出现 ADR,经地西泮静脉推注后缓解。 诺氏评分为 7 分,提示 ADR“很可能”与罗哌卡因相关。 文献复习表明,罗哌卡因毒性反应多 与血管内误注、剂量过大或个体代谢差异有关,儿童更易发生。 及时停药、气道支持与苯二氮 类药物是处理关键。 结论:罗哌 卡因在儿童可引起严重中枢毒性反应,即使规范操作仍存在风险。 应严格掌握用药指征,<12 岁慎用;注射过程中需反复回抽、 分次缓慢给药,并备齐抢救设备与药物,以保障用药安全。 |
| 关键词: 罗哌卡因 儿童 毒性反应 局部麻醉 不良反应 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2026.06.013 |
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| 基金项目: |
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| Treatment and Reflection on Central Toxicity Induced by Local Infiltration Anesthesia with Ropivacaine in Children: a Case Report and Literature Review |
| Deng Huaidong, Yang Yi, Dang Qingqin |
| (Panzhihua Hospital of Integrated Traditional and Western Medicine, Sichuan Panzhihua 617000, China) |
| Abstract: |
| Objective: To explore the clinical manifestations, risk factors, and management strategies of central toxicity induced by local infiltration anesthesia with ropivacaine in children. Methods: A case report of an 8-year-old male child who underwent circumcision and received local infiltration anesthesia with ropivacaine hydrochloride injection was analyzed. Within 1 minute, the child experienced central toxicity reactions such as generalized convulsions, muscle tremors, and foaming at the mouth. The causal correlation of adverse drug reactions (ADR) was evaluated by using the Naranjo scoring scale, and relevant literature was systematically reviewed. Results: The child rapidly developed typical central toxicity ADR after ropivacaine injection, and the symptoms were relieved after intravenous injection of diazepam. Naranjo’s score was 7 points, indicating that the reaction was “likely” related to ropivacaine. Literature review showed that the toxic reactions of ropivacaine were mostly induced by incorrect intravascular injection, excessive dosage, or individual metabolic differences, and children were more prone to occur due to immature liver enzyme system and underdeveloped blood-brain barrier. Timely drug withdrawal, airway support, and benzodiazepines were crucial in the treatment. Conclusion: Ropivacaine can cause severe central toxicity in children, and there are still risks even with standardized procedures. Clinically, medication indications should be strictly controlled to avoid routine use in children under 12 years. During the injection process, it is necessary to repeatedly withdraw and slowly administer the drugs in divided doses, and prepare rescue equipment and drugs to ensure medication safety. |
| Key words: ropivacaine children toxic reactions local anesthesia adverse drug reaction |
