连续硬膜外与静脉麻醉对小儿术后镇痛的效果比较

Comparison of continuous epidural and intravenous analgesia for postoperative pain control in children

目的对小儿患者全麻联合硬膜外麻醉及术后镇痛与全麻后芬太尼静脉给药镇痛效果进行比较。方法将91例行下肢畸形矫形术、阴道、阴茎成形术的小儿患者随机分为硬膜外利多卡因组(n=61)及静脉芬太尼组(n=30)。在手术过程中,控制呼气末氨氟醚浓度,使患儿血压及心率变化范围维持在术前数值的10%以内。在患儿术后返回病房即刻、6h、24h,测定家长视觉模拟量表(PVAS)、目标疼痛评分(OPS)、恶心及呕吐的发生率。结果硬膜外利多卡因组氨氟醚用量显著低于静脉芬太尼组(P<0.05)。硬膜外利多卡因组患儿返回病房6h后OPS显著低于静脉芬太尼组。在患儿返回病房即刻、6h及24h后硬膜外利多卡因组PVAS显著低于静脉芬太尼组。两组术后恶心及呕吐发生率没有显著性差异。结论全麻联合硬膜外麻醉与单独全麻相比呼气末氨氟醚浓度显著降低。在小儿术后,持续硬膜外自控镇痛与芬太尼静脉自控镇痛相比,患儿硬膜外自控镇痛术后疼痛评分显著降低,且没有严重并发症。

Objective： To compare the effect of combined general - epidural anesthesia and postoperative analgesia and fentanyl intravenously injected. Methods： 91 pediatric patients undergoing lower extremities surgery randomly divided into epidural lidocaine group （n=61 ） and IV fentanyl group （n =30）. During the operation, end - tidal enflurane concentration was controlled to maintain the blood pres- sure and heart rate within 10% of preoperative value. At the postoperative period, Parent Visual Analog Scale （ PVAS）, Objective Pain Score （OPS） and the incidence of nausea/vomiting were checked immediately, 6 hours and 24 hours after the patient＇s arriving at general ward. Results ： Enflurane was significantly lower in epidural lidocaine group than that in IV fentanyl group （ P 〈 0. 05 ） . Compare to Ⅳ fentanyl group, epidural lidocaine goup had significantly lower OPS at 6 hours after arrival. Epidural lidocaine group had significantly lower PVAS immediately 6 and 24 h after arrival. There was no significant difference in the incidence of postoperative nausea and vomiting between two groups. Conclusion： A combined general - epidural anesthesia could significantly decrease end - tidal enflurane concentration. Continuous patient - controlled epidural analgesia reduces postoperative pain scores significantly more than continuous patient - controlled IV fentanyl analgesia without any serious complications in pediatric lower extremity surgery.