不同剂量的舒芬太尼用于婴幼儿术后镇痛的比较

目的研究不同剂量的舒芬太尼用于婴幼儿术后镇痛的可行性,并探讨其最佳剂量。方法选择ASAⅠ～Ⅱ级、年龄2～36个月、择期行剖腹探查术患儿45例,随机分为3组（Ⅰ、Ⅱ、Ⅲ组）,麻醉方法相同,3组均在手术结束前30min连接镇痛泵。镇痛泵配方为舒芬太尼加生理盐水,具体Ⅰ组为1μg/kg、Ⅱ组为2μg/kg、Ⅲ组为3μg/kg,用生理盐水稀释至100ml。背景输注速率为2ml/h,每次按压快充0.5ml,锁定时间15min。分别在术后4、8、16、24、48h进行镇痛和镇静评分,并记录呼吸抑制、恶心、呕吐、皮肤瘙痒等不良反应发生情况。结果 3组患者在年龄、性别、体重、麻醉时间、手术时间上无明显差异,均完成了48h术后镇痛。Ⅰ组患者PCA有效按压次数明显高于其他组（P〈0.05）;Ⅰ组患者各时间点镇痛评分明显高于Ⅱ、Ⅲ组（P〈0.05）;Ⅱ、Ⅲ组各时点镇痛评分比较差异无统计学意义（P〉0.05）;Ⅰ组患者各时间点镇静评分明显高于Ⅱ、Ⅲ组（P〈0.05）;Ⅱ、Ⅲ组各时点镇静评分比较差异无统计学意义（P〉0.05）,Ⅲ组患者中有3例出现一过性呼吸抑制,另外两组均没有出现呼吸抑制。3组患者在镇痛期间均没有出现尿潴留及皮肤瘙痒。结论静脉持续输注舒芬太尼0.04μg/（kg·h）用于小儿术后镇痛效果满意,安全性高,是一种可行的小儿术后镇痛用药方案。

The comparison of analgesic effect of sufentanil at different doses on infant during postoperation

Objective To study analgesic effect of sufentanil at different doses on infant during postoperation,and to explore the most suitable dose.Methods45 cases of patients at the age between 2 to 36 months undergoing selective surgery of exploratory laparotomy with ASAⅠ～Ⅱ were divided into three groups randomly（groupⅠ、Ⅱ、Ⅲ）,and then accepted the same anesthesia.All patients began to use analgesia pump at 30min before the end of operation.The Analgesia pump contains sufentanil and saline;the doses of sufentanil are respectively 1μg/kg for groupⅠ,2μg/kg for groupⅡ,3μg/kg for groupⅢ.Then each one was diluted to 100ml with saline water.Background infusion rate was set at 2ml/h with each press leading to quick charge of 0.5 ml,and the locking time is 15min.Analgesia and sedation scores were assessed at 4、8、16、24、48h respectively in postoperation,and the incidence of adverse reaction including respiratory inhibition,nausea,vomiting,itch of skinitchy skin etc were recorded.ResultsThree groups of patients have no significant difference in age,sex,weight or time of anesthesia and operation,and they all received 48 hours postoperative analgesia.The frequency of effective press in groupⅠ is much higher than that in other groups（P 0.05）.Analgesia score of each time point in groupⅠ was significantly higher than that in groupⅡ,Ⅲ（P 0.05）;analgesia score between groupⅡand Ⅲ shows no significant difference（P〈0.05）.Sedation score of each time point in groupⅠwas significantly higher than that in groupⅡ,Ⅲ（P〈0.05）;sedation score between groupⅡand Ⅲ shows no significant difference（P〈0.05）,during the whole process,three patients in group Ⅲ suffered from respiratory inhibition,with none in other two groups.All patients did not have urine retention and itchy skin during analgesia.ConclusionContinuous infusion of sufentanil 0.04μg/（kg·h） through vein for pediatric postoperative analgesia has satisfactory effect,which is a feasible pediatric postoperative analgesia regimen.