不同剂量舒芬太尼复合曲马多用于烧伤患儿术后镇痛的比较

A comparison of different doses of sufentanil combine with tramadol in postoperative analgesia for pediatric burn patients

目的 比较不同剂量舒芬太尼复合曲马多用于烧伤患儿术后静脉镇痛（PCIA）的效果,并探讨舒芬太尼适宜剂量.方法 拟于全身麻醉下择期行躯干或四肢烧伤瘢痕整形术患儿60例,年龄3～10岁,ASAⅠ或Ⅱ级,随机均分为A、B、C组.术毕前30 min给予负荷量舒芬太尼0.15μg/kg,术后接镇痛泵,其中A组舒芬太尼0.03 μg·kg^-1·h^-1,B组舒芬太尼0.04 μg·kg^-1·h^-1,C组舒芬太尼0.05 μg·kg^-1·h^-1;三组均复合曲马多0.3mg·kg^-1 ·h^-1.分别在术后即刻（T1）、6 h（T2）、12 h（T3）、24 h（T4）和48 h（T5）采用改良面部表情评分法观察镇痛效果,记录FLACC评分和Ramsay镇静评分.观察并记录PCA按压次数及呼吸抑制、恶心、呕吐、头晕等不良反应.结果 与A组比较,T2～T5时B组和C组面部表情评分、FLACC评分明显降低、Ramsay镇静评分明显升高（P＜0.05）.B组和C组面部表情评分、FLACC评分和Ramsay镇静评分差异均无统计学意义.与A组比较,B组和C组PCA有效按压次数明显减少,C组恶心呕吐、头晕发生率明显升高（P＜0.05）.与B组比较,C组PCA有效按压次数明显减少、恶心呕吐、头晕发生率明显升高（P＜0.05）.结论 舒芬太尼0.04μgkg-1·h-1复合曲马多0.3 mg·kg^-1 ·h^-1用于小儿术后镇痛效果较好,不良反应少.

Objective To compare the postoperative analgesic effect of different doses of sufentanil combined with tramadol in pediatric burn patients,and find out the proper sufentanil dosage.Methods Sixty pediatric burn patients,ASA Ⅰ or Ⅱ,3-10 years old,were randomly divided into three groups（group A,group B,group C）.All children were given general anesthesia,and given sulfentanil 0.15 μg/kg 30 min before the end of operation.The children in group A were given sulfentanil 0.03 μg·kg^-1 ·h^-1 with tramadol 0.3 mg·kg^-1 ·h^-1,in group B sulfentanil 0.04μg· kg^-1 ·h^-1 with tramadol 0.3 mg·kg^-1 ·h^-1,and in group C sulfentanil 0.05 μg·kg^-1 ·h^-1 with tramadol 0.3 mg · kg^-1 ·h^-1.Record the heart rate,mean arterial pressure,respiratory rate,SpO2,improve faces pain rating scale,FLACC analgesia scale,Ramsay sedation scale and adverse reaction at 0 h,6 h,12 h,24 h,48 h after operation （T1-T5）.Results There were no significant differences in analgesia effects for each group at the end of operation.But there were significant differences in analgesia effects in groups B and C compared with group A （P〈0.05）.The higher the sulfentanil dose,the lower valid press number was observed.The incidences of nausea and vomiting and swirl in group C were slightly higher than those in group A and group B （P〈0.05）.Conclusion A loading dose of sulfentanil 0.15μg/ kg 30 min before the end of the operation followed by sufentanil 0.04μg·kg^-1 ·h ^-1 combined with tramadol 0.3 mg·kg^-1 · h^-1,is a better postoperative analgesia regime for pediatric burn patients.