舒芬太尼用于不同部位手术患儿的术后镇痛研究

Sufentanil for Postoperative Analgesia in Different Parts of Surgery in Children

目的探讨舒芬太尼用于不同部位手术患儿静脉术后镇痛的最佳剂量。方法180例患儿,ASAⅠ—Ⅱ级,其中行腹部手术的患儿60例,肌肉骨骼手术的患儿60例,会阴部手术的患儿60例,根据舒芬太尼浓度的不同将各部位手术的患儿随机分为3组,舒芬太尼1μg.kg-1.d-1(Ⅰ组)、舒芬太尼1.2μg.kg-1.d-1(Ⅱ组)、舒芬太尼1.4μg.kg-1.d-1(Ⅲ组),每组20例。术后24 h记录各组患儿的镇痛评分、镇静评分、镇痛泵按压次数和有效次数以及出现的不良反应等观察指标。结果腹部手术患儿3组间各观察指标比较差异无统计学意义(P>0.05)。肌肉骨骼手术患儿在镇静和镇痛评分方面,3组间比较差异无统计学意义(P>0.05);但Ⅰ组的按压次数和有效次数明显高于Ⅱ组和Ⅲ组,差异具有统计学意义(P<0.01)。会阴部手术患儿Ⅰ组的镇痛评分、按压次数、有效次数均明显高于Ⅱ、Ⅲ组,差异具有统计学意义(P<0.01)。结论舒芬太尼可安全用于小儿静脉术后镇痛,腹部手术的患儿建议用量为1μg.kg-1.d-1,肌肉骨骼手术的患儿1.2μg.kg-1.d-1,会阴部手术的患儿1.4μg.kg-1.d-1。

Objective To detect the optimal dose of sufentanil for postoperative analgesia in different parts of surgery in children.Methods A total of 180 pediatric patients（ASAⅠ—Ⅱ）were selected in this study,including 60 patients undergoing abdominal surgery,60 patients undergoing musculoskeletal surgery and 60 patients undergoing perineal surgery.Patients undergoing the same operation were divided in to three groups according to the dose of sufentanil used： group Ⅰ（1μg·kg-1·d-1）,group Ⅱ（1.2 μg·kg-1·d-1）and group Ⅲ（1.4 μg·kg-1·d-1）,with 20 patients in each group.Analgesic score,sedation score,PCA button pressing frequency,effective button pressing frequency and adverse effects were recorded at the 24 h after operation.Results There were no significant differences in all indexes among the three groups in children undergoing abdominal surgery（P〉0.05）.In children undergoing musculoskeletal surgery,no obvious differences in analgesic score and sedation score among the three groups,but PCA button pressing frequency and effective button pressing frequency in group Ⅰ were significantly higher than those in groupⅡ and group Ⅲ（P〈0.01）.In children undergoing perineal surgery,analgesic score,PCA button pressing frequency and effective button pressing frequency in group Ⅰ were obviously higher than those in groupⅡ and group Ⅲ（P〈0.01）.Conclusion Continuous infusion of sufentanil at a reasonable dosage can be safely used in postoperative analgesia in children.The optimal dose of sufentanil is 1,1.2 and 1.4 μg·kg-1·d-1 in patients undergoing abdominal surgery,musculoskeletal surgery and perineal surgery,respectively.