不同剂量氢吗啡酮复合舒芬太尼用于小儿术后静脉自控镇痛的效果比较

Comparison of Effects of Different Doses of Hydrogen Morphine Ketone Combined Sufentanyl on Self-Controlled Intravenous Analgesia in Children

目的 观察不同剂量氢吗啡酮复合舒芬太尼用于小儿术后静脉自控镇痛的效果,探讨氢吗啡酮的适宜剂量。方法 选择2018年3—11月安徽省儿童医院收治的拟全身麻醉下行发育性髋关节脱位矫正术患儿60例,依据处理方法不同分为H1、H2、S组,每组20例,术毕前15min给予负荷剂量舒芬太尼0.1μg/kg,并接静脉自控镇痛。H1组给予氢吗啡酮2μg/(kg·h)+舒芬太尼0.02μg/(kg·h),H2组给予氢吗啡酮3μg/(kg·h)+舒芬太尼0.02μg/(kg·h),S组给予舒芬太尼0.04μg/(kg·h),3组均加入盐酸托烷司琼0.1mg/kg和0.9%NaCl注射液至100mL,设定背景输注速率2mL/h,单次追加剂量0.5mL,锁定时间15min,持续输注48h。记录术后1h(T1)、3h(T2)、6h(T3)、12h(T4)、24h(T5)、48h(T6)的FLACC疼痛评分、Ramsay镇静评分、平均动脉压、心率;记录48h内自控镇痛按压次数、不良反应(皮肤瘙痒、恶心呕吐、呼吸抑制)发生情况。结果 与H1组比较,S组和H2组在T1、T2、T3、T4时FLACC评分、平均动脉压、心率更稳定(P<0.05);与H2组相比,S组和H1组T1、T2、T3时Ramsay评分显著降低(P<0.05)。H2组48h内自控镇痛按压次数少于S组、H1组[(1.8±0.7)次比(4.1±0.3)次、(3.9±0.5)次](P<0.05)。3组患儿总不良反应发生率比较差异无统计学意义(P>0.05),3组均未发生呼吸抑制、镇静过度等不良反应。结论 氢吗啡酮3μg/(kg·h)复合舒芬太尼0.02μg/(kg·h)用于小儿术后镇痛效果完善,不良反应少。

Objective To observe the effect of different doses of hydrogen morphine ketone combined sufentanyl on self-controlled intravenous analgesia in children,and to explore the appropriate dosage of hydrogen morphine ketone. Methods Sixty pediatric patients admitted to Anhui Provincial Children's Hospital from March to November2018,scheduled for developmental hip dislocation surgery or reconstruction of hypospadias under general anesthesia were enrolled and divided into three groups of H1,H2,S according to the treatment method( n =20).All children were given intravenous bolous sufentanil 0.1 μg/kg15 min before the end of operation and received postoperative patient- controlled intravenous analgesia.The children in group H1received hydromorphone2 μg/(kg·h) with sufentanil 0.02 μ g/(kg·h),group H2 received hydromorphone 3 μg/(kg·h) with sufentanil 0.02 μg/(kg·h),and group S received sufentanil 0.04 μg/(kg·h) for PCIA. The total volume was100 mL with saline and tropisetron Hydrochloride 0.1 mg/kg. Patient -controlled intravenous analgesia was set as followed:background infusion2 mL/h,bolus dose 0.5 mL and lock-out interval of15 min,48 hours continuously.FLACC (Face,Legs,Activity,Cry,Consolability) analgesia scale,Ramsay sedation scale,mean arterial pressure and heart rate at1h(T1),3 h (T2),6 h(T 3),12 h(T 4),24 h(T 5) and 48 h(T 6) after operation were recorded.The press number,the occurrence of pruirtus,nausea and vomiting and respiratory depression within posoperative 48 hours were also recorded. Results Compared with group H1, the FLACC analgesia scores,mean arterial pressure and heart rate were significantly decreased in group H2 and group S at T1-T 4( P <0.05).Compared with group H2, the Ramsay sedation scores were significantly decreased in group S and H1at T1-T 3.The times of pressing within 48 hours in group H2 were less than those in group S, and those in group H1[(1.8±0.7) times vs (4.1±0.3) times,(3.9±0.5) times]( P <0.05).There was no significant difference in incidence of total adverse reactions among the three groups( P >0.05).There was no respiratory depression or oversedation case. Conclusion 3 μg/(kg ·h) hydromorphone plus 0.02 μg/(kg·h) sufentanil can be effectively and safely used for postoperative intravenous analgesia in children.