舒芬太尼用于小儿骶管阻滞后术后镇痛的最适剂量

目的探讨舒芬太尼用于小儿骶管阻滞后术后镇痛的安全性、有效性和最适剂量。方法骶管阻滞下行择期下腹部手术患儿60例，年龄1～6岁，随机分为3组：Ⅰ组舒芬太尼术后镇痛剂量为0．8μg／（kg·d），Ⅱ组为1μg/（kg·d），Ⅲ组为1．2μg／（kg·d）。记录3组术后4h、8h、24h、48h各时点患儿心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）、记录自控镇痛（PCA）按压次数、患儿家长对镇痛的满意度以及呼吸抑制、恶心、呕吐、瘙瘁等不良反应。结果术后8h、24hFLACC量表评分Ⅰ组高于Ⅱ、Ⅲ组（P〈0．05），4hRR、Sp02m组低于Ⅰ、Ⅱ组（P〈0．05），PCA按压次数Ⅰ组高于Ⅱ、Ⅲ组（P〈0．05），家长对镇痛的满意度Ⅰ组低于Ⅱ、Ⅲ组（P〈0．05），3组不良反应发生率无显著差异（P〉0．05）。结论持续静脉输注舒芬太尼1μg／（kg·d）能安全有效地用于小儿术后镇痛，是小儿骶管阻滞后术后镇痛的最适剂量。

The optimal dosage of sufentanil for postoperative analgesia in children after caudal anesthesia

Objective To investigate the safety, efficacy and optimal dosage of sufentanil for postoperative analgesia in chiidren after caudal anesthesia. Methods Sixty chidren （ 1 to 6 years old） undergoing elective abdominal surgery were randomly divided into three groups ： Group Ⅰ（sufentanil0.8 8μg·kg^-1·d^-1）, GroupⅡ（sufentanil 1 μg·kg^-1·d^-1） and GroupⅢ（sufentanil 1.2μg·kg^-1·d^-1）. Heart rate （ HR）, mean arterial pressure （ MAP）, respiratory rate （ RR）, blood oxygen saturation （ SpO2 ） and FLACC scores were recorded at 4 h, 8 h, 24 h, 48 h after surgery. PCA pressing frequency, degree of satisfaction with analgesia and adverse effects such as respiratory depression, nausea, emesis and pruritus were also recorded. Results FLACC scores were higher in group Ⅰthan those of group Ⅱ and group Ⅲ at 8h and 24 h （ P 〈 0.05 ）. RR and SPO2 were lower in group Ⅱthan those in group Ⅰand group Ⅱat 4h （ P 〈 0.05 ）. PCA pressing frequency of group Ⅰwas higher than that of group Ⅱ and group Ⅲ （ P 〈 0.05 ）. The degree of satisfaction with analgesia in group I was lower than that of group Ⅱand group Ⅲ （ P 〈 0. 05）. The difference in adverse effects between three groups was not significant （ P 〈 O. 05 ）. Conclusion Continuous infusion of sufentanil 1 μg·kg^-1·d^-1 was the optimal dosage for postoperative analgesia in children after caudal anesthesia.