等效量舒芬太尼和芬太尼对新生儿术后镇痛的临床效果比较

Clinical Efficacy of Postoperation Analgesia for Neonates with Sufentanil or Fentanyl

目的观测新生儿术后静脉恒速持续输注等效量舒芬太尼、芬太尼镇痛期间的CRIES(镇痛评分)、NBNA(神经行为评分)和反映脑神经功能受损的S100β蛋白等指标。评估两药对新生儿镇痛的临床效果。方法将90例术后新生儿患者随机分为三组:舒芬太尼组(A组)、芬太尼组(B组)、无镇痛组(C组),各30例。A、B组患儿术后分别采用舒芬太尼0.025μg/kg.h和芬太尼0.25μg/kg.h静脉恒速持续输注48 h进行镇痛,C组采用非药物方法。以术后12、24、48、96 h的4个时点分别行CRIES评分(分值越高,疼痛程度越重)和NBNA评分(满分为40,<35为异常),同时采集患儿尿标本检测S100β蛋白含量。结果各对应时点C组CRIES分值均高于A、B组(P<0.05);术后36 h B组CRIES分值高于A组(P<0.05);神经行为观察:A、B组NBNA评分结果为38～39,C组NBNA评分明显低于A、B组(P<0.05)。检测尿S100β蛋白含量:4个时点C组均明显高于A组(P<0.01),48 h后B组S100β蛋白值高于A组(P<0.05),另外术后呕吐现象:B组2例,C组5例。各组均无呼吸抑制发生。结论应用上述剂量的舒芬太尼和芬太尼皆能安全有效进行新生儿术后镇痛,并对保护和促进新生儿神经系统功能恢复起到一定的作用。其中,舒芬太尼效果更佳。

Objective To evolute the efficacy of postoperation analgesia with sufentanil or fentanyl and their neuroprotective effect by detecting urinary S100β protein in neonates. Methods 90 neonates undergoing surgery were randomly divided into 3 groups ： group A and group B （ n = 30） respectively received continuous intravenous infusion of sufentanil（0. 025 μg·kg^-1 · h^-1 ） and fentanly（0.25 μg·kg^-1 · h^-1） , and control group C（ n = 30） had no analgesia. Heart rate（HR） , blood pressure（BP） , respiratory rate （RR） , oxygen saturation （ SaO2 ） , pain scores （CRIES） , NBNA （ Neonatal Behavioral Neurological Assessment）were monitored or assessed at fixed time after operation, urinary protein concentration of all neonates was measured in 12 h,24 h,48 h and 96 h after operation respectively. Results Comparing group C with A, B, the CRIES were increased significantly from 12 h to 48 h （P 〈 0.05） ; comparing group B with A, the CRIES were increased significantly at 36 h （P 〈 0.05） ; comparing group C with A and B,the NBNA was decreased significantly from 12 h to 96 h （P 〈0.05） ; comparing C with A and B group, the urinary S100β protein concentration were increased significantly from 12 h to 96 h, （P 〈0.01）; comparing group B with A, the urinary S100B protein concentration was increased significantly at 48 h and 96 h （P 〈 0.05 ） ; The incidence of PONV were significantly different between A, B group（ A,0/30,0% ; B ,5/30,16.67% ; P 〈0.05）. There was no significant difference in occurrence of others side effects. Conclusion Neonates postoperation analgesia with intravenous sufentanil （0. 025μg·kg^-1 · h^-1 ） or fentanyl （0.25μg·kg^-1 · h^-1 ） ensures a sufficient analgesia after operation. Postoperation analgesia can reduce the concentration of urinary S100β protein in neonates and play a significant role in alleviating neonatal brain damage and have neuroprotective effect.