帕瑞昔布钠用于不同年龄患儿日间手术后镇痛的适宜剂量

目的 探讨帕瑞昔布钠用于不同年龄患儿日间手术后镇痛的适宜剂量.方法 拟行腹股沟斜疝、鞘膜积液手术患儿180例,ASA分级Ⅰ级,年龄1～ 12岁,均采用七氟醚全身麻醉联合髂腹股沟神经阻滞麻醉,根据不同年龄分为3组(n=60):1～3岁组(Ⅰ组)、4～6岁组(Ⅱ组)和7～ 12岁组(Ⅲ组)；采用随机数字表法,每组随机分为A亚组和B亚组(n=30),于切皮即刻分别静脉注射帕瑞昔布钠0.5和1.0 mg/kg.Ⅰ组采用面部表情加行为综合评分法(FLACC)、Ⅱ组采用语言表达与行为联合的东安大略儿童医院疼痛评分方法(CHEOPS)、Ⅲ组采用视觉模拟评分法(VAS)评价镇痛效果.FLACC评分≤3分、CHEOPS评分≤7分或VAS评分≤3分为镇痛有效.于术后6 h(T1)、12h (T2)和24 h(T3)时记录疼痛评分及术后24h内不良反应的发生情况.结果 与B亚组比较,Ⅰ-A亚组T1时疼痛评分升高(P＜0.01),其余时点差异无统计学意义,Ⅱ-A亚组和Ⅲ-A亚组各时点疼痛评分差异无统计学意义(P＞0.05)；Ⅰ组术后镇痛有效率97％(Ⅰ-A亚组93％,Ⅰ-B亚组100％),Ⅱ组术后镇痛有效率100％,Ⅲ组术后镇痛有效率93％(Ⅲ-A亚组97％,Ⅲ-B亚组90％).Ⅰ组～Ⅲ组的2个亚组间不良反应发生率比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠1.0和0.5 mg/kg分别适于1～3岁和4～ 12岁患儿日间手术的术后镇痛.

Appropriate dosage of parexoxib sodium for postoperative analgesia in different ages children with day surgery

Objective To determine the appropriate dosage of parexoxib sodium for postoperative analgesia in different age children with day surgery.Methods One hundred and eighty ASA Ⅰ children aged 1-12 yr scheduled for day surgery undergoing sevoflurane anesthesia combined with lateral inguinal regional blockade were divided into 3 groups according to age ( n =60 each):group 1-3 yr (group Ⅰ ),group 4-6 yr (group Ⅱ ) and group 7-12 yr (group Ⅲ).Eeach group was randomly divided into 2 sub-groups( n =30): parecoxib sodium 0.5 mg/kg (sub-group A) and parecoxib sodium 1.0 mg/kg (sub-group B).Sub-groups A and B received iv injection of paracoxib sodium 0.5 or 1.0 mg/kg respectively immediately at skin incision.Analgesic effect was evaluated by FLACC score (group Ⅰ ),CHEOPS score (group Ⅱ ) and VAS scroe (group Ⅲ) at 6(T1 ),12(T2 )and 24 h (T3)after operation.The effective analgesia was defined as FLACC score≤3,CHEOPS score≤7 or VAS score≤ 3.Side effects were also observed.Results Compared with sub-group B,FLACC score was significantly increased at T1 in sub-group Ⅰ -A ( P ＜ 0.01 ).There was no significant difference in CHEOPS score or VAS score between sub-groups Ⅱ -A and Ⅱ -B,and between sub-groups Ⅲ-A and Ⅲ-B (P ＞ 0.05).The incidence of effective analgesia was 97％ in group Ⅰ (93％ in group sub-group Ⅰ -A,100％ in sub-group Ⅰ -B),100％ in group Ⅱ and 93％ in group Ⅲ (97％ in sub-group Ⅲ-A,90％ in sub-group Ⅲ-B).There was no significant difference in the incidence of side effect between sub-groups Ⅰ -A and Ⅰ -B,between sub-groups Ⅱ -A and Ⅱ -B,and between sub-groups Ⅲ-A and Ⅲ-B ( P ＞ 0.05).Conclusion Parecoxib sodium 1.0 or 0.5 mg/kg can be used in postoperative analgesia in children aged 1-3 yr or 4-12 yr with day surgery respectively.