不同剂量地佐辛用于小儿扁桃体腺样体切除术术后镇痛的效果观察

The effect observation of different doses of Dezocine used in postoperative analgesia of pediatric tonsillectomy and adenoidectomy

目的：观察静脉持续泵注不同剂量地佐辛用于小儿扁桃体腺样体切除术术后镇痛的安全性和有效性，探讨地佐辛用于小儿术后镇痛的合适剂量。方法选择择期行扁桃体腺样体切除术并要求术后镇痛的患儿120例，采用数字表法将患儿随机分为 A、B、C、D 组，每组30例。手术后进行患者自控静脉镇痛（PCIA），A、B、C 组分别给予地佐辛0．2、0．3、0．4 mg·kg －1·d －1持续静脉泵注，D 组给予苏芬太尼1μg· kg －1·d －1持续静脉泵注。观察并记录术后6 h、12 h、24 h 和48 h 镇痛评分和镇静评分；记录患儿术后48 h 内不良反应发生情况及镇痛泵按压次数、有效按压次数；记录患儿及家长对术后镇痛的总体评价。结果A 组各时间点镇痛评分明显高于 B、C、D 三组，差异均有统计学意义（tAB ＝12．003，PAB ＝0．049；tAC ＝7．542，PAC ＝0.036；tAD ＝40．990，PAD ＝0．009）；A、B、C 三组各时间点镇静评分明显低于 D 组，差异均有统计学意义（tDA ＝3．894，PDA ＝0．030；tDB ＝5．020，PDB ＝0．039；tDC ＝36．103，PDC ＝0．016）；D 组不良反应发生率明显高于 A、B、C 三组，差异均有统计学意义（χ2DA ＝20．738，PDA ＝0．000，χ2DB ＝4．35，PDB ＝0．029，χ2DC ＝5．98，PDC ＝0．025）；A 组术后48 h 内镇痛泵按压次数、有效按压次数明显高于 B、C、D 三组，差异均有统计学意义（tAB ＝3．003， PAB ＝0．036；tAC ＝5．720，PAC ＝0．031；tAD ＝37．157，PAD ＝0．015）；B、C 两组患儿及家长对术后镇痛总体评价满意率分别为90．0％、93．3％，明显高于 A、D 两组的63．3％、60．0％，差异均有统计学意义（χ2AB ＝5．310，PAB ＝0.031；χ2DC ＝19．640，PDC ＝0．000）。结论地佐辛0．3 mg·kg －1·d －1持续静脉泵注用于小儿扁桃体腺样体切除术术后镇痛是安全有效的，且不良反应少，值得推广。

Objective To observe safety and effectiveness of Dezocine in postoperative analgesia of pediatric tonsillectomy and adenoidectomy by the continuous intravenous infusion of different doses,and to explore appropriate dosage of Dezocine for pediatric postoperative analgesia.Methods Elective tonsillectomy and adenoidectomy require-ments of postoperative analgesia in children 120 cases,they were randomly divided into A,B,C,D groups of 30 cases by using number table.After surgery patient -controlled intravenous analgesia（PCIA）two days,A,B,C groups were given Dezocine 0.2,0.3,0.4mg·kg -1 ·d -1 continuous intravenous infusion,D group received Sufentanil 1μg· kg -1 ·d -1 continuous intravenous infusion.Observed and recorded pain scores and sedation scores for postoperative 6h,12h,24h and 48h;recorded adverse reactions,pressing the number and effective pressing times of children within 48h after surgery.;recorded overall evaluation of postoperative analgesia of children and parents.Results A group at each time point pain score was significantly higher than B,C,D three groups,the difference was statistically significant （tAB =12.003,PAB =0.049;tAC =7.542,PAC =0.036;tAD =40.990,PAD =0.009）;A,B,C three groups at each time point sedation score was significantly lower than D,the difference was statistically significant（tDA =3.894,PDA =0.030;tDB =5.020,PDB =0.039;tDC =36.103,PDC =0.016）;D group of adverse reactions were significantly higher than A,B,C three groups,the difference was statistically significant（χ2DA =20.738,PDA =0.000,χ2DB =4.35,PDB =0.029,χ2DC =5.98,PDC =0.025）;A group within 48h postoperative analgesia press times and the number of valid pressing were significantly higher than B,C,D three groups,the difference was statistically significant（tAB =3.003, PAB =0.036;tAC =5.720,PAC =0.031;tAD =37.157,PAD =0.015）;B,C two groups of children and parents to evaluate postoperative analgesia overall satisfaction rates were 90.0%,93.3%,significantly higher than A 63.3%,D 60.0%,and the difference statistically significant （χ2AB =5.310,PAB =0.031;χ2DC =19.640,PDC =0.000）. Conclusion Dezocine 0.3mg·kg -1 ·d -1 continuous intravenous infusion for pediatric tonsillectomy and adenoid-ectomy is safe and effective in postoperative analgesia and fewer adverse reactions,and should be promoted.