摘要
目的比较氟比洛芬酯超前镇痛复合不同剂量舒芬太尼对小儿骨盆截骨矫形术术后镇痛的效果,寻找适合小儿的术后镇痛模式。方法于我院小儿骨科选取拟于全麻下行骨盆截骨矫形术的3~10岁的先天性髋脱位病儿90例,将病儿随机分为N1、N2、N3共3组。3组切皮前均给予静脉注射氟比洛芬酯1mg/kg超前镇痛,病人自控镇痛(PCA)所用舒芬太尼的剂量分别为1.5、2.0、2.5μg/kg。PCA泵中昂丹司琼含量均为0.1mg/kg,加生理盐水至100mL。记录各组病儿在麻醉恢复室拔除气管插管时间,病儿术后2、4、8、12、24、48h的FLACC疼痛评分和Ramsay镇静评分,术后48h内PCA按压次数以及恶心、呕吐、呼吸抑制等不良反应。结果 3组病儿在恢复室的术后拔管时间差异无统计学意义(P>0.05)。FLACC评分比较,术后4、8、12h,N2组、N3组低于N1组,N3组低于N2组,差异有统计学意义(F=3.664~84.558,P<0.05);术后24、48h,N3组低于N1组,差异有统计学意义(F=4.225、8.667,P<0.05)。Ramsay评分比较,术后4、8、12h,N2组和N3组高于N1组,差异有统计学意义(F=5.367~24.996,P<0.05);术后24、48h,N3组高于N1组,差异有统计学意义(F=14.073、6.074,P<0.05)。术后48h内PCA泵按压次数,N1组13次,N2组7次,N3组3次,差异有统计学意义(χ~2=6.410,P<0.05)。N3组术后48h内恶心、呕吐发生率高于N1组和N2组,差异有统计学意义(χ~2=7.587,P<0.05)。结论氟比洛芬酯1mg/kg超前镇痛复合舒芬太尼2.0μg/kg是一种理想的小儿骨盆截骨矫形术的PCA模式。
Objective To evaluate the effect of preemptive analgesia of flurbiprofen axetil combined with different doses of sufentanil on children after pelvic osteotomy and look for the mode of postoperative analgesia in children. Methods Ninety children-three-to 10-year old-scheduled for elective innominate osteotomy under general anesthesia were enrolled and evenly randomized to three groups as N1,N2 and N3.Before skin incision,an intravenous injection of flurbiprofen axetil（1mg/kg）was given to patients in the three groups for preemptive analgesia,and the doses of sufentanil in patient-controlled analgesia（PCA）were1.5μg/kg for N1,2.0μg/kg for N2,and 2.5μg/kg for N3,respectively.The content of ondansetron in each PCA pump was 0.1mg/kg plus normal saline to 100 mL.Extubation time in anesthesia recovery room of the sick kids in each group was recorded.Postoperative FLACC score and Ramsay sedation score of 2,4,8,12,24 and 48hwere made,and the times of PCA press within 48 hours after surgery,as well as untoward effects such as nausea,vomiting and respiratory depression were recorded. Results The difference in postoperative extubation time in sick kids among the three groups were not significant（P〉0.05）.FLACC score showed that four,eight and 12 hours after surgery,the score of sick kids in groups N2 and N3was lower than that in group N1 and that in group N3 was lower than that in group N2,the differences being statistically significant（F=3.664-84.558,P〈0.05）;the score of 24 and 48hours in group N3 after surgery was lower than that in group N1（F=4.225,8.667;P〈0.05）.As for Ramsay score,the score of groups N2 and N3was higher than that in group N1-four,eight and 12 hours after surgery（F=5.367-24.996,P〈0.05）;and 24 and 48hours after surgery,the score of group N3 was higher than that of group N1（F=14.073,6.074;P〈0.05）.Concerning times of PCA button pressing,13 times in group N1,seven times in group N2 and three times in group N3,the difference was statistically significant（χ~2=6.410,P〈0.05）.The incidence of side effects was significantly higher in group N3 compared with groups N1 and N2（χ~2=7.587,P〈0.05）. Conclusion Preemptive analgesia of flurbiprofen axetil（1 mg/kg）combined with sufentanil（2.0μg/kg）is an ideal mode of patient-controlled analgesia for innominate osteotomy in children.
出处
《齐鲁医学杂志》
2017年第1期51-53,共3页
Medical Journal of Qilu
关键词
舒芬太尼
氟比洛芬酯
骨盆截骨术
儿童
镇痛
病人控制
sufentanil
flurbiprofenaxetil
pelvis
osteotomy
child
analgesia
patient-controlled
