不同剂量舒芬太尼复合曲马多在儿童消化道术后静脉自控镇痛中的应用对比

Application and comparison of different doses of sufentanil combined with tramadol for patient-controlled intravenous analgesia in children after digestive tract operation

目的探讨舒芬太尼在手术中的最佳剂量,研究其复合曲马多对儿童消化道手术的镇痛效果,了解剂量对舒芬太尼镇痛效果的影响。方法随机选取南京医科大学附属儿童医院的消化道疾病患儿84例为研究对象。84例患者均采用0.3 mg·kg^(-1)·h^(-1)的曲马多,所不同的是舒芬太尼的使用量,在随机分组的方法下将患者均分为低剂量组、中剂量组和高剂量组,分别给予的舒芬太尼速度为0.03μg·kg^(-1)·h^(-1)、0.04μg·kg^(-1)·h^(-1)以及0.05μg·kg^(-1)·h^(-1),观察三组患者的指标有一般生命体征、婴幼儿术后镇痛评分(children and infants postoperative pain scale,CHIPPS)等评分机制,除此之外还有PCA有效按压次数、并发症、满意度等指标。结果随着术后时间、镇痛时间的延长,中剂量组和高剂量组患儿的CHIPPS评分降低明显,而Ramsay评分则升高显著,差异具有统计学意义(P<0.05),而两组间比较则差异较小,无统计学意义(P>0.05)。对比高剂量组和中剂量组有效按压次数及并发症发生情况发现,高剂量组患儿的优势弱于中剂量组,差异具有统计学意义(P<0.05)。结论舒芬太尼剂量的不同对儿童消化道手术术后镇痛、镇静效果产生影响,复合曲马多后,以0.04μg·kg^(-1)·h^(-1)时效果最佳,并发症最少,且具有较高的满意度。

Objective To explore clinical efficacy of different doses of sufentanil combined with tra-madol for intravenous patient-controlled analgesia in children after gastrointestinal surgery. Methods A total of 84 pediatric patients undergoing gastrointestinal surgery were randomly divided into low dose group, middle dose group and high dose group according to different dosages of sufentanil at the rate of 0.03 μg·kg-1·h-1, 0.04μg·kg-1·h-1 and 0.05μg·kg-1·h-1 respectively with tramadol at 0.3 mg·kg-1·h-1 in all three groups. Index-es of three groups were postoperative pain [Children and Infants Postoperative Pain Scale （CHIPPS）], sedation [Ramsay Sedation Scale （RSS）], vital signs, complications, satisfaction and so on. Results With the extension of the postoperative time and analgesic time, the CHIPPS scores of the children in middle dose group and high dose group decreased significantly （P〈0.05）, while RSS scores significantly increased （P〈0.05）. The rates of PCA effective bolus and the incidence of complications were significantly different between middle dose group and high dose group （P〈0.05）. Conclusion The doses of sufentanil affect the outcomes on analgesic and sedative effects in pediatric patients following gastrointestinal surgery. Combined with tramadol, the dose of sufentanil at 0.04μg·kg-1·h-1 has a better effect and the lower complications as well as higher satisfaction.