不同剂量舒芬太尼用于小儿腹部手术后静脉镇痛的效果与安全性

The efficacy and safety of different doses of sufentanyl for continuous intravenous analgesia in children after abdominal surgery

目的采取随机对照临床实验的方法对不同剂量的舒芬太尼与吗啡用于小儿腹部手术后静脉镇痛的效果与安全性进行比较。方法90例ASA Ⅰ～Ⅱ级拟行腹部外科手术的患儿被随机分为舒芬太尼Ⅰ组：负荷剂量0．04μg／kg，维持剂量每小时0．032μg／kg（SF1，n=30）；舒芬太尼Ⅱ组：负荷剂量0．05μg／kg，维持剂量每小时0．04μg／kg（SF2，n=30）和吗啡组：负荷剂量40μg／kg，维持剂量每小时8μg／kg（M，n=30）。观察术后1、2、4、8、12、24、48h氧饱和度、疼痛评分、恶心呕吐及尿潴留发生率。结果3组之间氧饱和度评分无统计学差异（P〉0．05），但是SF2组部分病人氧饱和度评分低于94％。3组之间疼痛评分无统计学差异（P〉0．05）。在不良反应的发生上M组和SFI组、SF2组间比较有统计学差异（P〈0．05），SFI组和SF2组组间则无统计学差异（P〉0．05）。结论舒芬太尼可安全用于小儿腹部外科手术后的病人自控静脉镇痛（PCIA）。负荷剂量0．04μ／kg、维持剂量每小时0．032μg／kg作为PCIA镇痛剂量较为适合。

Objective To investigate the efficacy and safety of different doses of sufentanyl in continuous intravenous postoperative analgesia in a prospective, double-blind, randomized, controlled trials compared with morphine in pediatric patients underwent abdominal surgery. Methods After abdominal surgery, 90 patients given continuous intravenous analgesia were divided into 3 groups： SF1 group （a bolus dose of sufentanyl 0.04μg/kg and continuous intravenous infusion of sufentanyl 0. 032 μg·kg^-1·h^-1）, SF2 group （a bolus dose of sufentanyl 0. 05 μg/kg and continuous intravenous infusion of sufentanyl 0.04 μg·kg^-1·h^-1, and M group （a bolus dose of morphine 40 μg/kg and continuous intravenous infusion of morphine 8 μg·kg^-1·h^-1）. All drugs were added with droperidol with the continuous intravenous infusion of 0. 03μg·kg^-1·h^-1 and the lockout time was 10 minutes. Pain level （FLACC Behavioral Pain Assessment Tool 0- 10）, 02 saturation and adverse effects were evaluated at 1,2,4,8,12,24 and 48 h after surgery. Results There was no significant difference among the 3 groups in sex, age, weight and the sorts of surgery （P〉0.05）. There was no significant difference in 02 saturation （P〉0.05） among the 3 groups. The analgesic efficacy didn＇t have statistical difference among the 3 groups （P〈0. 05）. There was less adverse reactions in SFI group and SF2 group compared with M group （P〈0. 05）, and there was no statistical difference in adverse reactions between SF1 and SF2 groups. Conclusions The study shows that continuous intravenous analgesia with sufentanyl provides superior analgesia and higher patient satisfaction than morphine in children. A bolus dose of sufentanyl 0. 04 μg/kg and continuous intravenous infusion of sufentanyl 0. 032μg/kg^-1·h^-1may be appropriate in children.