摘要
目的研究不同剂量舒芬太尼对小儿先天性心脏病(先心病)术后的镇痛镇静效果。方法前瞻性选取2010年11月-2011年7月在本院小儿心脏科行手术治疗的ASD或VSD患儿84例,年龄3～144个月(平均34.2个月);体质量5.0～37.0 kg(平均13.1 kg)。将患儿随机分为3组,分别予0.02μg.kg-1.h-1(Ⅰ组)、0.03μg.kg-1.h-1(Ⅱ组)及0.04μg.kg-1.h-1(Ⅲ组)的舒芬太尼术后持续静脉泵入维持镇静镇痛,比较各组术后拔管时间、恶心呕吐发生率、用药期间临时加用咪达唑仑的发生率、拔管后因呼吸抑制二次插管的发生率,并于术后4 h、8 h、12 h、24 h、48 h记录心率(HR)、收缩压(SBP)、呼吸频率(RR)、中心静脉压(CVP)、血氧饱和度(SPO2)、Wong-Baker镇痛评分、FLACC镇痛评分及Ramsay镇静评分。结果使用舒芬太尼0.02～0.04μg.kg-1.h-1持续镇痛镇静评分结果均满意,组间差异无统计学意义(P>0.05)。术后24 hⅡ组和Ⅲ组RR高于该年龄组正常高限,其余各时间点生命体征均在正常范围。术后拔管时间比较差异无统计学意义(P>0.05)。3组恶心、呕吐发生率分别为6.7%、14.8%、22.2%,差异无统计学意义(P>0.05)。Ⅲ组较Ⅰ组单次加用咪达唑仑的发生率低,差异有统计学意义(P<0.05)。3组均无因呼吸抑制而进行二次插管。结论舒芬太尼可以安全地应用于先心病患儿术后的镇痛镇静,使用0.04μg.kg-1.h-1剂量时对疼痛治疗效果好,并且在此剂量下需要单次加用咪达唑仑对患儿进行镇静的发生率低。
Objective To investigate the effect of sufentanil used for postoperative analgesia and sedation with different doses in children and infants with congenital heart disease. Methods Eighty - four patients [ mean age 34.2 months （ ranged from 3 to 144 months） ; mean weight 13.1 kg（ ranged from 5.0 -37.0 kg） ] receiving ventricular septal defect repair and（or） atrial septal defect repair from Nov. 2010 to Jul. 20[1 were studied prospectively. The patients were randomly divided into 3 groups with different doses of sufentanil：group I ：0.02μg·kg^-1·h^-1, group II ：0.03μg·kg^-1·h^-1 , group ll1：0.04μg·kg^-1·h^-1. The time of extubation, the incidence of nausea and vomiting, the incidence of temporary use of midazolam, the incidence of reintubation because of respiratory depression, heart rate （ HR ） , systolic blood pressure （ SBP）, respiratory rate （ RR ）, central venous pressure （ CVP ）, blood oxygen saturation （ SPO2 ）, Wong - Baker Faces Pain Rating Scale, FLACC Scale, Ramsay scale were compared. Results It was satisfied on sedation and analgesia by using sufentanil from 0.02 μg·kg^-1·h^-1 to 0.04 μg·kg^-1·h^-1 postoperatively, the results of sedation and analgesia were good and had no significant difference between 3 groups （P 〉 0.05 ）. The HR, SBP, CVP, RR, SPO2 were normal except the RR was higher than that in group II and group III at 24 h after surgery. The time of extubation had no significant difference between 3 groups （P 〉 0.05 ）. The incidence of nausea and vomiting were 6.7 %, 14.8 % and 22.2%, respectively and it also had no significant difference between 3 groups （P 〉 0.05 ）. The incidence of temporarily use of midazolam were different between 3 groups （ P 〈 0. 05 ）. There was no reintubation because of respiratory depression. Conclusions Snfentanil can be safely used for postoperative sedation and analgesia for congenital heart disease patients, dose of 0.04μg·kg^-1·h^-1 had a good effect on pain release and lower incidence of using midazolam temporarily.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2012年第23期1841-1844,共4页
Journal of Applied Clinical Pediatrics
基金
北京市科技计划项目(z111100074911001)
