丁丙诺菲或舒芬太尼应用于小儿心脏手术后镇痛的疗效和安全性

目的 观察丁丙诺菲、舒芬太尼对先天性心脏病婴幼儿术后镇痛的疗效和安全性.方法 收集郑州大学第三附属医院2008年1-7月确诊为中小型室间隔缺损或(和)房间隔缺损并拟在静吸复合全身麻醉体外循环下行右侧开胸室间隔缺损或(和)房间隔缺损修补术的患儿45例,年龄1～3岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机均分成3组.术毕,C组以负荷量为0、维持量为2～3 mL/h经微量泵静脉注射0.9%氯化钠溶液;B组以负荷量为2μg/kg、维持量为0.5μg·kg~(-1)·h~(-1)经微量泵静脉注射丁丙诺菲;S组以负荷量为0.2μg/kg、维持量为0.075μg·kg~(-1)·h~(-1)经微量泵静脉注射舒芬太尼.于术后8(T_1)、14(T_2)、24(T_3)、32 h(T_4)4个时间点进行观察.结果 3组间一般资料、气管导管拔管时间的差异均无统计学意义(P值均>0.05).3组在各时间点的动脉血二氧化碳分压(PaCO_2)的差异均无统计学意义(P值均>0.05),C组在T_1、T_2、T_33个时间点的疼痛行为评估量表(FLACC)疼痛评分显著高于B、S组(P值均<0.05),B组又显著高于S组(P值均<0.05).C组在5个时间点的血清皮质醇(Cor)水平的差异无统计学意义(P值均>0.05).B、S组在T_1、T_2、T_3、T_4时间点的血清Cor水平均显著低于同组T_0时间点(P值均<0.05).在T_0时间点C、B、S组间血清Cor水平的差异均无统计学意义(P值均>0.05).C组在T_1、T_2、T_3、T_4时间点的血清Cor水平显著高于B、S组(P值均<0.05),而B组又显著高于S组(P值均<0.05).在T_2时间点,3组的血清Cor水平均显著高于生理标准范围的上限值598 mg/L~(-1)(P<0.05).C、B、S组发生烦躁的次数分别为(11.20±1.32)、(8.87±1.36)和(6.93±1.33)次,3组间差异有统计学意义(P值均<0.05);3组间发生恶心、呕吐次数的差异均无统计学意义(P值均>0.05).结论 丁丙诺菲、舒芬太尼应用于小儿先天性心脏病术后镇痛均安全、有效,舒芬太尼的镇痛效果更完善,且不良反应更小.

Efficacy and safety of postoperative analgesia after cardiac surgery in infants:a comparison between buprenorphine and sulfentanil

Objective To observe the efficacy and safety of buprenorphine and sulfentanil for postoperative analgesia in infants after cardiac surgery. Methods Forty-five patients aged 1-3 years with ventricular or(and) atrial septal defect (American Society of Anesthesiologists class Ⅰ-Ⅱ), who were treated in our hospital during Jan. 2008 to Jul. 2008, were included in the present study. The patients were divided into 3 groups: control group was given normal saline;group B was given buprenorphine, and group S was given sulfentanil. Group C was given normal saline with an injection speed of 2-3 mL/h by microinfusion pump. Group B was given bolus infusion of buprenorphine 2 μg/kg and continuous infusion of 0.5 μg·kg~(-1)·h~(-1). Group S was given bolus infusion of sufentanil 0.2 μg/kg and continuous infusion 0. 075 μg·kg~(-1)·h~(-1). The data were observed at postoperation (T_0), 8 h(T_1), 14 h(T_2), 24 h(T_3) and 32 h(T_4). Results The general data pressure of arterial carbon dioxide (PaCO_2) and the time of extubation were similar between the three groups. The scores of the Face, Legs, Activity, Cry, Consolability Pain Scale (FLACC) of the three group at T_1,T_2, and T_3 were significantly different (P<0.05). The differences of cortisol (Cor) values of the five time points in the C group was not significantly different (P>0.05). The Cor value at the four time points in group B and S were significantly smaller than at T_0 (P<0.05). The differences of the Cor value at T_0 of the three groups were not significantly different (P>0.05). The difference of Cor values at T_1, T_2, T_3, and T_4 in the three groups were significantly different (P<0.05). The Cor values of the three group at T_2 was significantly higher than the ceiling value of the physiological standard (μ=598 mg/L, P<0.05). The frequencies of fidget were significantly different between the three groups (11.20±1.32 vs. 8.87±1.36 vs. 6.93±1.33, P<0.05). The frequencies of vomiting in the three groups were similar. Conclusion Postoperative analgesia with buprenorphine or sulfentanil for infants with congenital heart disease is safe and effective, and the analgesic effect of the latter is better, with less side effects.