舒芬太尼用于小儿氯胺酮基础麻醉骨科手术后镇痛的剂量探析

The Optimal Dose of Sufentanil for Analgesia on Pediatric Patients Undergoing Orthopedic Surgery after Ketamine Based Anesthesia

目的：探讨舒芬太尼在使用氯胺酮基础麻醉后行骨科手术的小儿患者达到适宜镇痛效果的最佳剂量。方法：将60例择期行骨科手术需术后镇痛的5～10岁患儿随机分为4组，每组15例，术前注射氯胺酮1～2mg／kg，分别于麻醉清醒后采用病人自控镇痛技术使用舒芬太尼0．025μg／kg（S1组）、0．035μg／kg（S2组）、0．045μg/kg（S3组）和0．055μg/kg（S4组）术后镇痛。评估4组患儿在静脉镇痛后0．5h（T1）、1h（T2）、2h（13）、6h（T4）及12h（T5）的视觉模拟评分（VAS）、Ramsay镇静评分、需要按压镇痛泵次数及各组患儿出现的不良反应等。结果：随着舒芬太尼浓度增加，VAS评分逐渐降低，S2、S3组患儿在T2、T3及T4时间点的VAS评分比较差异无统计学意义，其余各组在相同时间点比较差异有统计学意义（P〈0．05）。与S1组比较，其余各组按压镇痛泵次数减少，差异有统计学意义（P〈0．05），S2、S3及S4组均能获得满意的镇痛效果。随着舒芬太尼浓度增加，Ramsay评分显著增加（P〈0．05）。与S1、S2组比较，S3及S4组患儿恶心、呕吐发生率较高（P〈0．05）。结论：舒芬太尼可作为使用氯胺酮基础麻醉后行骨科手术的小儿患者术后镇痛的理想静脉用药，推荐最佳剂量为0．035μg／kg。

Objective：To investigate the optimum dose of sufentanil for analgesia on pediatric patients undergoing orthopedic surgery after ketamine based anesthesia. Methods： Sixty patients （5 - 10 years old ） undergoing elective orthopedic surgery required postoperative analgesia were randomly divided into four groups. Before operation, 1 - 2 mg/kg ketamine were injected intravenously. After patients awaked from anesthesia, patient-controlled analgesic （PCA） techniques were applied with sufentanil 0. 025 μg/kg （group S1 ）, 0. 035 μg/kg （ group S2 ）, 0. 045 μg/kg （ group S3 ） and 0. 055 μg/kg （ group S4） to investigate the optimum dose of sufentanil. The analgesic and sedative effect, bolus times of PCA pump and side effects of the four groups after PCA 0.5 hour （T1）, 1 hour （ T2）, 2 hours （T3）, 6 hours （T4） and 12 hours （T5） were assessed. Results： There was no statistical difference about the VAS between S2 and S3 at the moment of T2, T3 and T4, but the comparison of VAS in other groups in the remaining moments showed that the VAS decreased significantly with the increase of sufentanil doses. At the same time, the bolus times of PCA pump were decreased. All the children of S2, S3 and S4 were achieved excellent analgesia. As the sufentanil increased, the Ramsay scores increased significantly （P〈0.05）. The incidences of nausea and vomiting were significantly higher in S3 and S4 compared to S1 and S2 （ P 〈 0.05 ）. Conclusions： Sufentanil can afford good analgesia effect for pediatric patients undergoing orthopedic surgery after ketamine based anesthesia, and the optimum dose of sufentanil is 0. 035 μg/kg.