舒芬太尼复合地塞米松在小儿骨科术后静脉自控镇痛泵的效果观察

Efficacy of sufentanil in combination with dexamethasone for intravenous analgesia in children after orthopedic surgery

目的观察舒芬太尼复合地塞米松用于小儿骨科手术后静脉自控镇痛(Patient controlled intravenous analgesia,PCIA)的临床效果及安全性。方法选择我院择期全麻下行骨科手术术后行PCIA的患儿90例,随机分为3组:舒芬太尼2μg/kg组(S2组)、舒芬太尼1.5μg/kg+Dex 150μg/kg组(S+D组),舒芬太尼1.5μg/kg组(S1.5组),三组均加入雷莫司琼6μg/kg。用0.9%氯化钠注射液稀释到100 mL注入镇痛泵。以2 mL/h持续泵入,自控给药单次剂量0.5 mL,锁定时间15 min。记录PCIA开始后4、8、12、24、48 h各时点WongBanker面部表情镇痛评分(FPS-R评分)、Ramsay镇静评分、血流动力学变化、血氧饱和度,不良反应发生率以及PCIA需求按压次数。结果 (1)PCIA开始后4、8、12和24 h,S+D组和S2组FPS-R镇痛评分和Ramsay镇静评分差异均无统计学意义(P>0.05),镇痛效果满意;S+D组和S2组FPS-R镇痛评分均低于S1.5组(P值均<0.05),Ramsay镇静评分均高于S1.5组(P值均<0.05);三组在48 h FPS-R镇痛评分和Ramsay镇静评分差异均无统计学意义(P>0.05);(2)三组患儿平均动脉压(MAP),心率(HR)和血氧饱和度(SpO2)差异均无统计学意义(P>0.05);(3)S+D组嗜睡发生率低于S2组(P<0.05),而S+D组恶心呕吐发生率均低于S2组的13.3%和S1.5组的6.7%(P<0.05);S+D组按压次数与S2组差异无统计学意义,此两组按压次数均少于S1.5组,有统计学差异(P值均<0.05)。结论舒芬太尼1.5μg/kg复合地塞米松用于小儿骨科手术术后PCIA不良反应少,血流动力学稳定,镇痛及镇静效果优于单独应用舒芬太尼1.5μg/kg,而与舒芬太尼2μg/kg镇痛及镇静效果相当,但不良反应发生率降低,是一种较理想的应用于小儿骨科术后静脉镇痛方法。

Objective To investigate the efficacy and safety of sufentanil in combination with dexamethasone for patients controlled intravenous analgesia （PCIA） in children after orthopedic surgery. Methods 90 children given continuous intravenous analgesia after orthopedic surgery were randomly divided into 3 groups： sufentanil （2 pLg/kg） was in group S2, sufentanil（ 1.5 μg/kg） and dexamethasone（ 150μg/kg） were in group S ＋ D, sufentanil（ 1.5 μg/kg） was in group $1.5. Then each one was added with ramosetron 6 μg/kg. Normal saline was added to a total volume of 100 mL in each group. Background infusion rate was set at 2 mL/h with each press leading to quick charge of 0. 5 mL, and the locking time was 15 min. Outcome including analgesia score（FPS-R） and sedation score（Ramsay） , hemodynamic（ HR ,MAP）and oxygen saturation ,times of PCIA press and side-effects were observed postoperatively at 4,8, 12,24 and 48 hours after PCIA. Results （ 1 ） There was no significant difference between group S ＋ D and S2 in FPS- R and Ramsay scores and times of PCIA after operation at time point of 4,8,12 and 24 h（ P 〉 0. 05 ）. FPS-R scores in group S ＋ D and S2 were much lower than that in group S1.5, otherwise Ramsay scores of group S ＋ D and S2 were higher than that in group S1.5 （ P 〈 0.05 ） ;Three groups of FPS-R and Ramsay scores had no significant difference at time of 48 h （ P 〉 0. 05 ） ; （ 2 ） There was no significant difference in hemodynamic （ HR and MAP） and oxygen saturation among the 3 groups （ P 〉 0. 05 ） ; （ 3 ） The incidence rate of somnolence in S ＋ D group was significantly lower than that in group S2 （ P 〈 0. 05 ）. The incidence of nausea and vomiting in group S ＋ D were remarkably lower than those in group S2 and St. 5. The frequency of using PCIA administration for group S ＋ D and S2 were much lower than that for group SI. 5 （P 〈 0. 05 ）, while there was no significant difference between the former two groups （P 〉 0. 05 ）. Condusion Sufentanil 1. 5 μg/kg combined with dexamethasone is a good method for intravenous analgesia to relieve pain for children after orthopedic surgery with better analgesic and sedative effect than sufentanil 1.5μg/kg and less side effects than sufentanil 2 μg/kg.