舒芬太尼术后镇痛对新生儿应激反应的影响

目的 评价舒芬太尼术后镇痛对新生儿应激反应的影响.方法 择期拟行腹部手术的足月新生儿90例,ASAⅡ或Ⅲ级,日龄1～30 d,体重2.4～5.5kg,随机分为3组(n=30),术毕患者清理拔除气管导管后,生理盐水对照组(N组)静脉输注生理盐水2 ml/h,芬太尼组(F组)静脉输注芬太尼0.3μg·kg~(-1)·h~(-1),舒芬太尼组(S组)静脉输注舒芬太尼0.03μg·kg~(-1)·h~(-1),均输注至术后24 h.分别于术毕、术后4、8、12及24 h时监测呼吸频率、平均动脉压、心率及脉搏血氧饱和度,采用CRIES评分表行疼痛评分;分别于术前、术毕、术后12及24 h时采集外周静脉血样,测定血糖、血浆皮质醇及β-内啡肽浓度.结果 与N组比较,F组和S组术后8、12及24 h时心率、平均动脉压及疼痛评分降低,S组术后12 h时血糖降低,术后12、24 h时皮质醇浓度升高,F组和S组术后12 h时β-内啡肽浓度降低(P<0.05);与F组比较,S组术后12 h时血糖降低,术后12、24 h时皮质醇浓度升高(P<0.05);S组和F组镇痛满意率较N组升高(P<0.05).结论 术毕静脉输注舒芬太尼0.03μg·kg~(-1).h~(-1)至术后24 h镇痛效果较好,可抑制新生儿术后疼痛引起的应激反应.

Effects of postoperative analgesia with sufentanil on stress response in neonates

Objective To evaluate the efficacy of postoperative analgesia with sufentanil and its effects on stress response in neonates.Methods Ninety ASAⅡ or Ⅲ neonates (age 1-30 d, weight 2.4-5.5 kg) undergoing abdominal surgery including radical operation for megacolon were randomly divided into 3 groups ( n = 30 each): control group received normal saline ( N ) ;sufentanil group received iv infusion of sufentanil at 0.03μg·kg~(-1)·h~(-1) (S) and fentanil group received iv infusion of fentanyl at 0.3μg·kg~(-1)·h~(-1) . Postoperative pain was assessed and scored at the end of operation and at 4, 8, 12 and 24 h after operation based on 5 criteria: (1) crying (0-2) : (2)O_2 inhalation is needed to maintain SaO_2 > 95% (0-2);(3) increase in BP and HR (0-2) ;(4) expression (0-2) and (5) sleeplessness (0-2). The results were rated as satisfactory analgesia 0-3;moderate pain 4-6 and severe pain 7-10. Venous blood samples were taken before and at the end of operation and at 12 h and 24 h after operation for determination of blood glucose level and serum cortisol and fi-endorphin concentrations. Results The 3 groups were comparable with respect to age, body weight, ASA physical status and duration of operation. The percentage of satisfactory analgesia was significantly higher in group S (90%) and F (80%) than in group N (40% ) . The blood glucose concentration was significantly increased at the end of operation as compared with baseline before operation in all 3 groups and returned to baseline level at 12 h after operation in group S, at 24 h after operation in group F but remained increased in group N. There was no significant difference in serum cortisol and fi-endorphin concentrations before and after operation in group S while in group F and N serum cortisol level was significantly decreased and fi-endorphin level was significantly increased after operation as compared with the baseline before operation. Conclusion Postoperative analgesia with iv infusion of sufentanil provides adequate analgesia which can suppress stress response induced by postoperative pain.