舒芬太尼和吗啡对先天性心脏病患儿术后镇痛的比较

[摘要] 目的 比较舒芬太尼和吗啡在先天性心脏病患儿术后镇痛中的效果和不良反应，以指导临床工作。方法 120例择期行室间隔缺损修补术患儿，随机分成舒芬太尼组（S组，n＝60）和吗啡组（M组，n=60）。S组术后镇痛选择舒芬太尼0.04μg.kg-1.h-1，M组采用吗啡15μg.kg-1.h-1，各组都加用格拉司琼3mg，并以生理盐水稀释到250ml。术毕送回重症监护室，当患儿清醒后开启镇痛泵，按5ml.h-1的速度持续静脉镇痛，两组的镇痛治疗时间均为50h。分别在术后6h、12h、24h、48h对患儿进行镇痛（Wong-Baker脸谱评分法）、镇静（Ramsay评分）评分，并记录呕吐、尿潴留、呼吸抑制、皮肤瘙痒等不良反应和患儿生命体征。结果 各时点S组患儿的Wong-Baker脸谱镇痛评分均比M组低，差异有统计学意义（P<0.05）；各时点两组患儿镇静评分无统计学差异；M组的呕吐、尿潴留发生率均高于S组，有统计学差异（P<0.05）。两组患儿生命体征都平稳，均未出现呼吸抑制和皮肤瘙痒等不良反应。结论 舒芬太尼在先天性心脏病患儿中术后镇痛的效果优于吗啡。

The clinic research of postoperative analgesia in children with congenital heart disease

[Abstract] Objective To compare the postoperative analgesic efficacy and adverse effects of sufentanil and morphine in children with congenital heart disease. Methods 120 children were randomly allocated into sufentanil group (S group, n=60) and morphine group (M group, n=60), S group received sufentanil 0.04μg.kg-1.h-1 and granisetron 3mg, M group received morphine 15μg.kg-1.h-1 and granisetron 3mg, analgesic solutions were diluted to 250ml with normal saline in two groups. Duration of analgesic was 50h in two groups. Delivered children to CICU after operations, opened analgesic pump when they were awoke, the infusion rate was 5ml.h-1 and duration of analgesia was 50h in two groups. The scores of pain and sedation were recorded at the time points of 6, 12, 24, 48h postoperative. Wong-Baker face and Ramsay were used to estimate pain level and sedation level respectively. Life sign and the side effects as vomiting, urine retention, respiratory depression and titillation were also recorded at the same time point. Results S group got a significantly lower pain score than M group (P<0.05) at any time point. Score of sedation in two groups had no significant difference. The vomiting and urine retention incidence rate of M group were higher than S group (P<0.05). Life sign was good in all children, and respiratory depression and titillation didn’t happen. Conclusion The postoperative analgesic efficacy of sufentanil was better than morphine in children with congenital heart disease.