不同剂量右美托咪定复合舒芬太尼用于小儿术后镇痛的临床研究

目的 探讨右美托咪定用于小儿术后镇痛的安全性及合适剂量.方法 选择我院2015年8月至2016年10月择期行四肢骨折手术患儿60例,按手术时间分为右美托咪定低剂量(1μg/kg)+舒芬太尼组(D1组)、右美托咪定中剂量(1.5μg/kg)+舒芬太尼组(D2组)、右美托咪定高剂量(2μg/kg)+舒芬太尼组(D3组)、舒芬太尼组(S组),每组15例.观察并记录术后4 h、8 h、12 h、24 h、48 h 5个时间点患儿的视觉模拟评分(VAS评分)、Ramsay镇静评分、镇痛满意度以及不良反应发生率.结果 D1、D2、D3组患者术后各时间点VAS评分明显低于S组,D2、D3组在术后8 h VAS评分明显低于D1,差异均有统计学意义(P<0.05),其余各时段D2、D3组与D1组比较差异均无统计学意义(P>0.05);D2、D3组患者的PCA按压次数在术后0~24 h明显少于S组,其中在4~12 h按压次数明显少于D1组,差异均有统计学意义(P<0.05);PCA期间未出现皮肤骚痒、心动过缓及呼吸抑制,其中S组有2例(13.3%)出现恶心,无呕吐;D3组有1例(6.67%)出现过度镇静.结论 1.5μg/kg右美托咪定复合舒芬太尼用于小儿术后静脉镇痛可以获得满意的效果,比单用舒芬太尼效果更佳,副反应更少.

Clinical study on sufentanil combined with different dosages of dexmedetomidine in the treatment of postoperative analgesia in children

Objective To evaluate the safety and right-optimal safe dose of dexmedetomidine for postoperative analgesia in children. Methods A total of 60 children with limb fractures, who admitted to our hospital and underwent limb fractures surgery from August 2015 to October 2016, were selected as the research subjects and randomly divided into the D1 group (1μg/kg of dexmedetomidine+sufentanil), the D2 group (1.5μg/kg of dexmedetomidine+sufentanyl) and the D3 group (2 μg/kg of dexmedetomidine + sufentanil), and the S group (sufentanil group) according to natural date order, with 15 cases in each group. The visual analogue scale (VAS score), Ramsay sedation score, analgesic satis-faction and incidence of adverse reactions at 4 h, 8 h, 12 h, 24 h, 48 h after surgery were recorded. Results The VAS scores at each time point in the D1, D2, D3 group were significantly lower than that in the S group (P<0.05). The VAS scores at 8h after surgery in the D2 and D3 group were significantly lower than that in the D1 group (P<0.05), while there was no significant difference between the D1, D2, D3 group at the other time points (P>0.05). Patient-controlled analgesia (PCA) press times at 0-24 h after surgery in the D2, D3 group were significantly less than that in the S group (P<0.05), and press times at 4-12 h after surgery in the D2, D3 group were significantly less than that the D1 group (P<0.05). Skin itching, bradycardia and respiratory inhibition do not appear during the PCA. Two cases (13.3%) of the complications of no vomiting and nausea occurred in the S group, and one case (6.67%) of excessive sedation occurred in the D3 group. Conclusion The dose of 1.5 μg/kg dexmedetomidine combined with sufentanil can obtain satisfactory results in the treatment of postoperative analgesia in children, which is better than sufentanil alone, with fewer side effects.