婴幼儿先天性心脏病矫治术后芬太尼联合咪唑安定的镇痛效果观察

目的观察应用静脉持续泵注芬太尼联合咪唑安定，在小儿先天性心脏病矫治术后镇痛的效果及不良反应。方法选择40例择期行先天性心脏病矫治术婴幼儿随机分为镇痛组和对照组，各20例。镇痛组用芬太尼0.5—2μg／（kg·h）持续静脉微量泵注入；对照组给予布洛芬5—8mg／（kg·次）。两组均用咪唑安定0．01—0．2mg／（kg·h）静脉持续微量泵注入或0.05～0．1mg／（kg·次）间断静脉推注镇静。观察术后2、8、24、48h的镇静、镇痛效果同时行Ramsay、Comfort评分；观察恶心、呕吐、心率及血压下降、呼吸抑制等的不良反应情况。结果镇痛组和对照组术后2、8、24h，两组Ramsay、Comfort评分差异显著（P〈0．05），而48h两组Ramsay、Comfort评分无显著差异。镇痛组20例患儿中有1例出现一过性心率减慢、血压下降，数分钟后恢复。未用机械呼吸患儿用药期间未发现呼吸抑制、喉痉挛等不良反应。镇痛组、对照组无恶心、呕吐、消化道出血等不良反应。结论婴幼儿心内直视术后应用芬太尼联合咪唑安定持续静脉泵注在婴幼儿先心术后早期可以达到良好的镇静镇痛效果，安全有效并值得在临床推广。

Observation of the sedation and analgesia effects of fentanyl and midazolam on post-operation infants with congenital heart disease

Objective To obese the sedation and analgesia effects and adverse flects of infusing Fentanyl and Midazolam on post-cardiac surgery in infants.Methods Forty patients with congenital heart disease used in two groups for sedation.The effects and adverse effects of the sedation and analgesia were observed on 2 h,8 h,24 h,48 h after surgery of each group.And Ramsay,Comfort value were assessed simultancously in each group.Results There were significant difference in Ramsay、Comfort value on 2 h,8 h,24 h(P<0.05),and no differentce on 48 h between the two groups.Only one case in analgesia group showed temporarily bradycardia and hypotension and recovered in several minutes.No nausea,vomiting and bleeding were observed in the two groups.Conclusion The sedation and analgesia of midazolam and Fentanyl can be used safely and effectively in infants on the early stage of post-cardiac surgery.