芬太尼联合表面麻醉在早产儿视网膜病激光光凝术的镇静镇痛研究

Effect of sedation and analgesia of fentanyl combined with proparacaineon on ROP laser photocoagulation

目的研究芬太尼联合表面麻醉在早产儿视网膜病激光光凝术中镇静镇痛的效果。方法收集2011年1月1日-2013年10月31日广东省妇幼保健院新生儿科收治、按照ROP国际分类标准和早产儿治疗用氧和视网膜病变防治指南标准,需行激光光凝术的125例早产儿,均已达3期阈值病变需要激光光凝术。随机分为芬太尼联合组(芬太尼联合表面麻醉组)和对照组(表面麻醉组)两组分别为61和64例。比较两组术前、手术开始后1 h、手术结束时、术后1 h、术后24 h的心率、血氧饱和度、平均动脉压,术后3天末梢微量血糖、血常规指标,C-反应蛋白、降钙素原、术后1周的胃肠道情况、术后3天的术后至出院前的颅脑影像学检查。对结果进行统计分析。结果 1芬太尼联合组术前、术中和术后1h心率为(133.7±5.2)、(143.7±4.3)和(144.2±3.3)次/分,平均动脉压为(39.5±3.4)、(41.4±2.8)和(40.5±2.7)mm Hg,血氧饱和度为(95.2±5.3)、(88.7±3.6)和(92.0±4.8)%,差异无统计学意义。表面麻醉组术前、术中和术后1h心率为(130.2±4.7)、(148.7±5.3)和(153.3±3.9)次/分,平均动脉压为(38.8±4.1)、(42.5±3.5)和(41.3±3.1)mm Hg,血氧饱和度为(94.5±3.7)、(88.7±3.6)和(92.0±4.8)%,与术前相比,差异均具有统计学意义。2芬太尼联合组术前、术后1天的白细胞为(10.8±5.4)和(13.6±5.3)×109/L,CRP为(2.90±1.4)和(3.12±2.1)mg/L,血糖为(4.40±1.2)和(4.58±1.3)mmol/L,差异均无统计学意义。表面麻醉组术前和术后1天的白细胞为(11.3±6.2)和(15.7±5.7)×109/L,CRP为(2.88±1.8)和(7.78±2.9)mg/L,差异具有统计学意义。3芬太尼联合组中术后胃储留、腹胀、呕吐、消化道出血和坏死性小肠结肠炎(NEC)发生率为16.4、13.1、21.3、3.2和1.6%,表面麻醉组为39.1、43.7、35.9、12.5、4.6%;血糖为(3.88±1.8)和(6.88±0.9)mmol/L.4芬太尼联合组和表面麻醉组分别有3例和5例颅内出血,差异无统计学意义。结论与单纯表面麻醉相比,芬太尼联合表面麻醉镇静镇痛可以减少术中术后期间患儿生命体征和血糖的波动,降低胃肠道不良反应和感染的发生,减少早产儿视网膜病激光光凝术的不良反应。

Objective To study the effects of fentanyl combined with proparacaineon the sesation and analgesia of laser photocoagulation in retinopathy of prematurity（ROP） infants. Methods 125 infants hospitalized in Guangdong Women and Children hospital from January 1, 2011 to October 31, 2013 were enrolled in the study, all were diagnosed 3 phase threshold ROP and should have laser photocoagulation according to the ROP international classification. They were divided into Fentanyl combined group （Fentanyl ＋ Proparacaine） and Proparaeaine group（ control）, Heart rate, blood oxygen saturation, mean arterial pressure, routine blood test, blood glucose, CRP, PCT, gastrointestinal tract situation and Cranial ultrasound were studied before, during and after photocoagulation. SPSS17.0 statistical software were used to analysis the data, which were shown as means ± standard deviation. multiple samples mean were compared by single factor analysis of variance. Difference between groups were compared with LSD or SNK methods and gualitative variable was compared by chi-square test. The difference was statistically significant if P 〈 0.05. Results Heart rate in Fentanyl combined group before, during and 1 hour after laser photocoagulation was （133.7 ± 5.2 ）, （143.7 ± 4.3 ） and （ 144.2 ± 3.3 ） bpm, mean arterial pressure was （ 39.5 ± 3.4 ）, （41.4 ± 2.8 ） and （40.5 ± 2.7 ） mmHg; oxygen saturation was （95.2 ＋ 5.3）, （88.7 ± 3.6） and （92.0 ± 4.8 ） %, all without obvious difference. In Proparacaine group, However, Heart rate was （130.2 ±4.7） ,（148.7 .＋5.3） and （153.3 ~3.9）hpm,mean arterial pressure was （38.8 ±4.1） ,（42.5 ±3.5） and （41.3 ±3.1） mmHg,oxygen saturation was （94.5 ± 3.7 ） , （ 88.7 ± 3.6 ） and （ 92.0 ± 4.8 ） %. WBC in Fentanyl combined group before and 1 hour after laser photoeoagulation （ 10.8 ± 5.4 ） and （ 13.6 ± 5.3 ） x 109/L, CRP was （2.90 ± 1.4） and （ 3.12 ± 2.1 ） mg/L, blood glueose was （4.40 ± 1.2） （4.58 ~ 1.3 ） mmol/L,in Proparaeaine group, WBC was （ 11.3 ± 6.2 ） and （ 15.7 ± 5.7 ） x 109/L, CRP was （2.88 ± 1.8） and （7.78 ± 2.9） mg/L,blood glucose was （3.88 ± 1.8 ） and （6.88 ± 0.9 ） mmol/L. @The incidence of gastric retention, vomiting, abdominal distension and neonatal neerotizing enterocolitis was 16.4% , 13. 1% ,21. 3% , 3.2% , 1.6% in Fentanyl combined group and 39. 1% ,43.7% ,35.9% , 12.5% ,4.6% in Proparaeaine group. @There were 3 and 5 cases cranial hemorrhage in Fentanyl combined group and Proparaeaine group without any difference. Conclusions Compared with proparaeaine, fentanyl combined with proparaeaine may could rduee the fluctuation of vital signs and blood glucose, decrease the gastrointestinal adverse reactions and infection, finally reduce the side effects of laser photocoagulation.