摘要
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.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第8期758-761,共4页
Journal of Clinical Anesthesiology
关键词
舒芬太尼
曲马多
烧伤手术
儿童
术后镇痛
Sulfentanil
Tramadol
Brun injury surgery
Child
Postoperative analgesia