小儿术后两种镇痛方法的效果观察

Effects of fentanyl administrated nasally and intravenously in post-operative analgesia in pediatric children： a comparative study of 36 cases

目的观察小儿术后两种镇痛方法的效果及不良反应。方法选择ASAⅠ～Ⅱ级，年龄4～8岁，体重16—24kg，下腹部择期手术小儿40例，麻醉选择异丙酚静脉全麻。术毕患者清醒后按OPS评分法记录疼痛程度，评分超过6分的36例，随机分为两组，A组17例，B组19例。A组经鼻滴入芬太尼0．5μg/kg，后静推0．9％氯化钠1ml；B组经鼻滴入0．9％氯化钠1ml，后静推芬太尼0．5μg/kg。用药后5min行疼痛评分1次，OPS评分≥2分者给相同剂量的药物，后每1min评分1次，5min后OPS评分≥2分者，再给药1次，以此类推，直至患儿评分≤2分。记录达到OPS评分≤2分的时间及用药量，并观察不良反应。首次给药60min后，两组继以原给药方案每小时单次给药，直到术后24h。记录给药后4、8、12、18、24h的OPS评分，并观察不良反应。结果A、B两组达到OPS评分≤2分所需时间差异无统计学意义（P〉0．05）；A组芬太尼用量较B组大，差异有统计学意义（P〈0．05）；B组不良反应较重，与A组相比差异有统计学意义。A组滴鼻时舒适度与B组相比差异无统计学意义，两组4h后的OPS评分差异无统计学意义，12h前不良反应发生率B组较A组高，12h后两组不良反应发生率差异无统计学意义。结论经鼻滴入芬太尼用于小儿下腹部手术术后镇痛起效时间与静脉给药差异无统计学意义，用量较大，舒适度满意，不良反应发生率较低。

Objective To observe the effectiveness and adverse reactions of fentanyl used by nasal infusion or intravenous injection in post-operative analgesia in pediatric patients. Methods Forty children, underwent selective lower abdomen surgery under intravenous anesthesia. At the end of operation, 36 patients with the scores 〉 6 according to the Objective Pain Scale （OPS） were randomly divided into 2 groups, Group A （ n = 17 ） undergoing nasal administration of fentanyl 0.5μg/kg, then intravenous injection of 1 ml 0.9% sodium chloride, Group B group （ n = 19 ） undergoing nasal administration of 1 ml 0.9% sodium chloride and then intravenous injection of fentanyl 0. 5 μg/kg. Five rain later pain scoring was conducted. Those with the OPS score ≥2 received the same protocol once, and then scoring was conducted every 1 min. Another 5 min later the same protocol was used to those still with the OPS score ≥ 2 once again. Such a protocol was continued till the OPS score ≤ 2. Sixty rain after the first administration, the primary scheme was carried out once per hour until 24 h later. Results The time needed to achieve the OPS score ≤2 of Group A was （ 16± 5 ） rain, not significantly different from that of Group B [ （ 14±5 ） min, P 〉 0.05 ]. The amount of fentanyl used in Group A was （21± 5 ） μg, significantly higher than that of Group B [ （15 ±7）μg, P 〈 0.05 ]. When the OPS score ≤2 was achieved the dizziness rate of Group B was 31.58% , and the nausea/vomiting rate of Group B was 21.05%, both significantly higher than those of Group A （ 11.76% and 31.58% respectively, both P 〈0.05）, however, there were significant differences in the adverse reaction rates since 12 h after the first administration. There were no significant differences in the OPS score 4 h after the first administration. Conclusion There are not significant differences in the time needed to achieve the analgesic effect in the pediatric children who undergo lower abdomen surgery. Nasal administration of fentanyl needs a higher dose with a higher comfort and lower adverse reaction rate.