小儿尿道下裂修复术后舒芬太尼镇痛的最低有效剂量

摘要: 目的 探讨舒芬太尼静脉输注用于小儿尿道修复术后镇痛的最低有效剂量。方法 纳入2～4岁行尿道下裂修复手术的小儿,在吸入诱导下行单次骶管阻滞（0.25％罗哌卡因1ml/kg），术中静脉输注丙泊酚（50ug•kg-1•min-1）维持小儿镇静。静脉注射舒芬太尼0.1ug/kg后，静脉通路连接镇痛泵，以2ml/h速度持续输注舒芬太尼，采用改良序贯法选择舒芬太尼剂量。盲法评估小儿术后1h、4h、8h、24h、48h疼痛和镇静，并记录不良反应。结果 共观察40例小儿，仅有1例术后8h出现轻度恶心，没有发生呼吸抑制和皮肤瘙痒。舒芬太尼剂量为2 ug•kg-1•d-1、1 ug•kg-1•d-1和0.75 ug•kg-1•d-1时，所有小儿镇痛效果良好。舒芬太尼剂量为0.5 ug•kg-1•d-1时，术后有4例小儿需要追加镇痛药物。结论 2～4岁小儿尿道下裂修复术后，舒芬太尼静脉镇痛的最低有效剂量为0.75 ug•kg-1•d-1。关键词：舒芬太尼；术后镇痛；儿童；尿道下裂修复术

The optimal dose of sufentanil for postoperative analgesia in children

Abstract: 【Objective】 The purpose of this study was to evaluate the optimum dose of sufentanil intravenous for postoperative analgesia in children undergoing reconstruction of hypospadias. 【Method】Using a modified up-and-down approach, with 10 children in each study group, a starting dose of 2 ug•kg-1•d-1 of sufentanil was administered intravenous to provide postoperative analgesia. After each group of 10 patients, the results were analyzed, and if all postoperative analgesia were successful, the dose of sufentanil was decreased by 50%, and a further 10 patients were enrolled into the study. Failure to achieve a 100% success rate within a group subjected patients to an automatic increase of half the previous dose reduction to be used in the subsequent group. 【Results】 Using 2 and 1 ug•kg-1•d-1 of sufentanil, the sucess rate was 100%.With a dose of 0.5 ug•kg-1•d-1 of sufentanil, 4 of 10 children received additional analgesia. Therefore, according to the protocol, the amount was increased to 0.75 ug•kg-1•d-1 of sufentanil, where the success rate was again 100%. 【Conclusion】Sufentanil intravenous for postoperative analgesia in children undergoing reconstruction of hypospadias allowed a reduction of the dose of Sufentanil to 0.75 ug•kg-1•d-1. Key words: sufentanil; postoperative analgesia; children; reconstruction of hypospadias