60例小儿骨科患者术后静脉自控镇痛条件优化的临床观察

Clinical Optimization Trail of Patient-controlled Intravenous Analgesia in 60 Pediatric Patients after Orthopaedics Surgery

目的研究不同剂量的芬太尼用于小儿术后静脉自控镇痛的临床效果。方法选择60例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级小儿骨科手术患儿,随机分为3组,每组20例,于术毕接静脉自控镇痛泵分别给予芬太尼8μg/kg(Ⅰ组)、10μg/kg(Ⅱ组)和12μg/kg(Ⅲ组),分别观察给药后4、8、12、24、48 h的镇痛评分、镇静评分及不良反应。结果Ⅰ组各时点的镇痛评分均高于Ⅱ、Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组各时点之间镇痛评分差异无统计学意义(P>0.05)。Ⅲ组各时点镇静评分高于Ⅰ、Ⅱ组,差异有统计学意义(P<0.05)。Ⅲ组术后恶心呕吐、皮肤瘙痒、尿潴留等不良反应发生率(45%)高于Ⅰ、Ⅱ组(分别为5%和10%),差异有统计学意义(P<0.05)。结论芬太尼用于小儿骨科术后病人静脉自控镇痛的安全有效剂量以10μg/kg为宜。

Objective To evaluate the clinical efficacy of patient-controlled intravenous analgesia （PCIA） with fentanyl after pediatric surgery, to compare the efficacy and security of different dosages of fentanyl. Methods 60 pediatric patients with ASA Ⅰ-Ⅱ grade underwent orthopedic surgeries under epidural anesthesia and general anesthesia were randomly divided into three groups： Group I received fentanyl 8 μg/kg i.v., Group II received fentanyl 10 μg/kg i.v., and Group III received fentanyl 12 μg/kg i. v. for postoperative analgesia, respectively. The scores of pain and sedation, adverse reaction were recorded at 4, 8, 12, 24 and 48 h after operation. Results All patients accomplished postoperative analgesia. Pain score in group I was significantly higher than that in group II and III（P〈0.05 ）, and there was no difference between group II and group III （P〉0.05）. Sedation score of group III was significantly higher than that of group I and group II （P〈0.05）. The incidence rates of postoperative nausea, vomiting, pruritus and urine retention in group III were significantly higher than those in group I and II （P〈0.05）, and the adverse reaction rates of group I and group II were lower than that in group III （P〈0.05）. Conclusions Optimal PCIA dosage of fentanyl for children with satisfactory effect and less adverse reaction may be 10 μg/kg i.v.