不同剂量芬太尼静脉自控镇痛在小儿胸外科术后中的应用

Clinical application of postoperative patient-controlled intravenous analgesiawith different dosages of fentanyl in pediatric chest surgery for children

目的比较不同剂量芬太尼用于小儿胸外科术后静脉自控镇痛（PCIA）的效果和安全性。方法将90例胸外科手术患儿（ASAⅠ-Ⅱ级）于术后随机分为F1、F2、F3三组各30例，均采用芬太尼行PCIA，芬太尼持续剂量分别为0．1、0．15、0．2μg/（kg·h），单次追加剂量0．25μg/kg，锁定时间20min，1h最大量1μg／kg。观察两组不同时间点镇痛、镇静评分，芬太尼用量、按压次数（D1）、有效按压次数（D2），D1／D2，总体满意度及不良反应。结果疼痛及镇静评分：F1组在0．5、2、8、12h高于F3组（P〈0．05）；F2组在0．5、2h高于F3组（P〈0．05）；芬太尼总用量、D1、D1／D2、总体满意度及不良反应发生率F1组〈F2组〈F3组（P〈0．05）。结论认为芬太尼行PCIA用于儿童术后镇痛安全、有效，持续输注剂量以0．2μg/（kg·h）为宜。

Objective To compare the efficacy and security of patientcontrolled intravenous analgesia （PCIA） with different dosages of fentanyl in pediatric chest surgery for children. Methods 90 ASAⅠ～Ⅱ pediatric patients underwent pediatric chest surgery were randomly given postoperative intravenous infusion of 0.1 μg/（ kg· h） fentanyl（ group F1 ）, 0.15μg/（ kg·h） fentany]（ group F2 ）, 0.2μg/（ kg · h） fentanyl（ group F3 ）. PCIA was continued for 24 h, with fentan- gl single dose of 0.25 μg/kg, lock time of 20 rain, maximum dose in 1 h of 1μg/kg. Ondansetron was added to PCIA. The scores of pain and sedation, dosage of fentanyl , frequency of press （ D1 ） , utility frequency of press （ D2 ） , SpO2, HR, RR, adverse reaction, satisfaction at the point of 24 h after operation and D1/D2 were recorded. Results The score of pain in group F1 was significaptly higher than that in group F3 at the point of 0. 5,2,8,12 h （P 〈0.05 ）, the score of pain in group F2 was significantly higher than that in group F2 at the point of 0.5,2 h （P 〈 0.05 ）. The score of sedation in group F1 was significantly lower than that in group F3 at the point of 0.5,2,8,12 h （P 〈 0.05 ）, the score of sedation in group F2 was significantly lower than that in group F3 at the point of 0.5,2 h （P 〈0.05 ）. The total dosages of fentanyl, D1, D1/D2 satisfaction and adverse reaction of group F1 〈 group F2 〈 group F3（ P 〈0.05 ）. Conclusion Optimal PCIA dosage of fentanyl for children may be 0.2 μg/（ kg·h）.