丙泊酚与瑞芬太尼联合应用对小儿扁桃体切除术的镇痛效果评价

目的采用等渗生理盐水、丙泊酚＋瑞芬太尼、罗哌卡因＋瑞芬太尼三种方案处理小儿扁桃体切除术中的疼痛，并进行效果评价，旨在探讨小儿扁桃体切除术中理想的控制疼痛的用药方案。方法前瞻性的双盲设计，选取90例接受扁桃体切除术的患儿为研究对象，分析比较不同镇痛方案的效果。结果平静休息时，术后当天，安慰剂组患者的疼痛评分明显高于丙泊酚＋瑞芬太尼治疗组（P〈0．05）；术后第1天，三组患者的疼痛均明显上升，三组患者的疼痛指数比较无统计学差异（P〉0．05）；术后第5天和第7天，安慰剂组患者的疼痛评分均明显高于丙泊酚＋瑞芬太尼组及罗哌卡因＋瑞芬太尼组（P〈0．05）。术后当天、术后第5天、术后第7天，饮水时安慰剂组患者的疼痛评分均明显高于丙泊酚＋瑞芬太尼组及罗哌卡因＋瑞芬太尼组（P〈0．05）；丙泊酚＋瑞芬太尼组患者的恶心、呕吐发生率明显低于安慰剂组（P〈0．05）。结论丙泊酚＋瑞芬太尼用于儿童扁桃体切除术中的镇痛药物，效果确切，起效快，不良反应少，有积极的临床意义。

The analgesic effect of combined application of Propofol and Remifentanil in pediatric tonsillectomy

Objective To apply three programs including isotonic saline, Propofol ＋ Remifentanil and Ropivacaine ＋ Remifentanil to pediatric tonsillectomy and evaluate their effects so as to find out an ideal pain control regimen. Methods Prospective double- blind design was conducted and 90 children （patients） undergoing tonsillectomy were selected for the study, and comparative analy- sis of different analgesic effectiveness was made up. Results At calm rest on the day after surgery, the patients＇ pain score of the placebo group was significantly higher than that of the Propofol ＋ Remifentanil treatment group （ P 〈 0.05 ）. On postoperative day 1, the three groups were significantly increased in pain degree, and the three groups of patients had no significant difference in pain scores （ P 〉 0.05 ） ; on postoperative day 5 and 7, pain scores of the placebo group were significantly higher than of the Propofol ＋ Remifentanil group and the Ropivacaine ＋ Remifentanil group （P 〈 0.05 ）. When drinking, after the first, the fifth and the seventh day, the pain scores of the placebo group were significantly higher than that of the Propofol ＋ Remifentanil group and the Ropiva- caine ＋ Remifentanil group （ P 〈 0.05 ） ; nausea and vomiting of the Propofol ＋ Remifentanil group were significantly less than that of the placebo group （ P 〈 0.05 ）. Conclusion The application of Propofol ＋ Remifentanil acts as analgesic treatment for tonsillec- tomy in children. Its effect is exact and rapid, without obvious adverse reactions.