芬太尼持续静脉滴注在早产儿视网膜病光凝术中的镇痛效果及安全性研究

A study on the analgesic effects and safety of continuous intravenous infusion of fentanyl in laser photocoagulation for retinopathy of prematurity

目的探讨芬太尼持续静脉滴注在早产儿视网膜病（ROP）光凝术中镇痛的安全性和有效性。方法将2014年3月至2015年1月我院收治、需进行ROP光凝术的患儿按照抽取信封方式随机分为对照组和芬太尼组，其中对照组采用单纯表面麻醉，芬太尼组采用芬太尼联合表面麻醉。术中用早产儿疼痛量表（PIPP）对患儿进行疼痛评分，记录心率、平均动脉压的变化，以及术后3d内不良反应发生情况，检测手术前后血皮质醇、肾上腺素和去甲肾上腺素浓度，采用t检验、非参数秩和检验及x^2检验比较两组问差异。结果共纳入82例患儿，其中对照组40例，芬太尼组42例。芬太尼组和对照组患儿术中PIPP评分最高分≥6分（疼痛阈值）的比例分别为11．9％和70．0％，差异有统计学意义（P〈0．05）。芬太尼组患儿手术开始0minPIPP评分、术中PIPP评分最高分和手术结束时PIPP评分分别为2．0、3．0和1．5分，对照组分别为8．0、8．0和8．0分，两组比较差异均有统计学意义（P〈0．05）。芬太尼组患儿手术前后血清肾上腺素、去甲肾上腺素、皮质醇浓度比较差异均无统计学意义（P〉0．05）；对照组患儿手术后血清肾上腺素、去甲。肾上腺素、皮质醇浓度均升高，与手术前比较差异均有统计学意义（P〈0．05）。芬太尼组和对照组患儿术后3d内不良反应发生率分别为19．0％和40．0％，差异有统计学意义（P〈0．05）。结论患儿在新生儿重症监护病房内进行ROP光凝术时，与表面麻醉相比，芬太尼联合表面麻醉患儿的疼痛评分更低，应激反应更小，术后不良反应更少，是一种安全、有效的镇痛方法。

Objective To study the safety and efficacy of continuous intravenous infusion of fentanyl in laser photocoagulation of retinopathy of prematurity （ROP）. Methods From March,2014 to January, 2015, ROP infants hospitalized for laser photocoagulation in Guangdong Women and Children hospital were randomly （ using envelope method） assigned into the fentanyl groupand the control group. In the fentanyl group, the patients were given fentanyl combined with topical anesthesia, while onlytropical anesthesiain the control group. Premature infant pain profile （PIPP） scores, heart rate, mean artery pressure and complications within 3 days after operation were recorded. The concentration of epinephrine, norepinephrine and cortisol in the blood were measured before and afterthe operation. Student＇s t test, non- parameter rank and chi-square test were used to compare the differences between the two groups. Results A total of 82 infants were enrolled in the study, 42 in the fentanyl group and 40 in the control group. In the fentanyl group, 11.9% infants had maximum PIPP score ≥6 and 70. 0% in the control group, the difference was statistically significant （ P 〈 0. 05）. In the fentanyl group, the PIPP score at the beginning of operation, the maximum PIPP score during operation and the PIPP score at the end of operation were 2. 0, 3.0and 1.5, respectively. In the control group, these scoreswere 8.0, 8.0and 8.0 respectively. The differences were statistically significant （P 〈 0. 05 ）. No significant differences existed between the concentration of epinephrine, norepinephrine and cortisol before and after operationin the fentanyl group. However, these concentrations were elevated after the operation than before the operation in the control group （ P 〈 0. 05 ）.The incidence of complications within three days after operation was 19. 0% in the fentanyl group and 40. 0% in the control group, and the difference was statistically significant （P 〈 0. 05 ）. Conclusion Comparing with topical anesthesia, fentanyl combined with topical anesthesia has lower pain scores, less stress responses and fewer complications during R0P laser photocoagulation. Fentanyl combined with topical anesthesia is a safe and effective analgesic method during ROP laser photocoagulation.