舒芬太尼和芬太尼在小儿术后静脉镇痛的效果比较

Comparison of sufentanil with fentanyl during postoperative patient-controlled intravenous analgesia in pediatric patients

目的比较舒芬太尼和芬太尼在小儿术后静脉镇痛的疗效及其不良反应。方法全身麻醉术后患儿80例，随机分为4组，每组20例。F1组为芬太尼20μg／kg、氟哌利多40μg／kg；F2组为芬太尼20μg／kg、昂丹司琼100μg／kg；S1组为舒芬太尼2μg／kg、氟哌利多40μg／kg；S2组为舒芬太尼2μg／kg、昂丹司琼100μg／kg，各组均加生理盐水至100ml。观察各组术后HR、MAP、RR及SpO2、VAS评分，Ramsay改良评分、PCA按压次数以及不良反应发生率。结果术后各时点MAP、HR、RR以及SpO。各组间差异无统计学意义（P〉O．05）。4个时点的VAS评分亦无统计学差异（P〉0．05）。术后Ramsay改良评分及各组PCA按压次数的差异均无统计学意义（P〉0．05）。F1组恶心、呕吐的发生率高于F2、S1和s2组（P〈0．05）。各组均未见呼吸抑制。F1和F2引起皮肤瘙痒的发生率低于S1和S2组（P〈0．05），F1和S1组出现锥体外系症状高于F2和s2组（P〈0．05）。结论舒芬太尼或芬太尼复合昂丹司琼均能有效地应用于小儿术后静脉镇痛，安全、可靠，舒芬太尼偶有皮肤瘙痒。昂丹司琼止吐效果好，氟哌利多镇吐时易使患儿发生锥体外系症状。

Objective To compare the efficacy and side-effects of sufentanil with fentanyl during postoperative patient-controlled intravenous analgesia in pediatric patients. Methods Eighty pediatric patients, aged from 5 to 10 years old, were randomly divided into four groups, 20 pediatric patients in each. Fentanyl （20 μg/kg） and droperidol （40μg/kg） were in group F1, fentanyl （20μg/kg） and ondansetron （100μg/kg） in group F2, sufentanil （2 μg/kg） and droperidol （40μg/kg） in group S1 , sufentanil （2 μg/kg） and ondansetron （100μg/kg） in group S2. Normal saline was added to 100 ml in each group. The HR, MAP, respiratory rate （RR） and SpO2, VAS , Ramsay scores, times of PCA and side-effects were observed postoperatively. Results There was no significant difference among four groups in HR, MAP, RR, SpO2, VAS , Ramsay scores and times of PCA after operation（P〉0.05）. The incidence of the skin itch in group：S1 and group S2 was much higher than that in group F1 and group F2. Extrapyramidal symptom in group F1 and group S1 was much higher than that in group F2 and group S2. Respiratory depression was not observed. Conclusion Sufentanil or fentanyl combined with ondansetron was a good method to relieve the pain for pediatric patients after operation by patient-controlled intravenous analgesia, which was safety and reliability. Skin itch sometimes occurred in some patients with sufentanil. Ondansetron was a kind of good medicine for relieving vomit. Extrapyramidal symptom is easily happened side effect with droperidol.