曲马多联合托烷司琼在儿童先天性心脏病介入术后镇静镇痛及并发症控制中的作用

Effect of tramadol combined with tropisetron on sedation and analgesia and complications control in children with congenital heart disease after percutaneous transcatheter closure

目的探讨曲马多联合托烷司琼在儿童先天性心脏病介入术后镇静镇痛效果及并发症控制中的作用。方法选取2015年6月至2019年6月西南医科大学附属医院儿二科确诊先天性心脏病并行介入治疗的患儿170例为研究对象,按术后镇痛药物不同分为实验组和对照组:(1)实验组:患儿于介入手术结束时予以曲马多(1 mg/kg)+托烷司琼(0.1 mg/kg)分别加入生理盐水稀释至10 mL后静脉缓慢推注;(2)对照组:患儿于介入手术结束时在穿刺部位予以罗哌卡因(3 mg/kg)局部浸润注射。两组患儿给药时间均在拔出鞘管前,拔出鞘管后立即予以穿刺部位局部加压、包扎。分析两组患儿术后的疼痛程度、穿刺部位出血或血肿、瘀斑、封堵器移位或脱落、残余分流、低血压、恶心呕吐、心律失常等并发症的发生情况,并对先天性心脏病患儿介入术后疼痛程度与并发症的发生之间存在的相关性进行分析。结果实验组患儿的中度和重度疼痛发生率明显低于对照组,无痛和轻度疼痛发生率明显高于对照组,差异具有统计学意义(Z=8.221,P<0.001);实验组患儿术后瘀斑的发生率明显低于对照组,差异具有统计学意义(χ2=6.538,P<0.05);实验组患儿术后血肿或出血、心脏彩超残余微量分流、心律失常的发生率均低于对照组,但差异无统计学意义(P>0.05),实验组和对照组患儿均无封堵器移位或脱落、低血压、恶心呕吐、心包压塞等并发症发生。先天性心脏病患儿介入术后疼痛程度与术后并发症的发生之间存在正相关性。结论在儿童先天性心脏病介入术后,使用曲马多联合托烷司琼,镇静镇痛效果良好,较罗哌卡因更有利于控制术后并发症,并能提高患儿介入手术后的舒适性和感受。

Objective To investigate the effect of tramadol combined with tropisetron on sedation and analgesia and control of complications in children with congenital heart disease after percutaneous transcatheter closure.Methods A total of 170 children with congenital heart disease diagnosed in the Department of Pediatrics of the Affiliated Hospital of Southwest Medical University from June 2015 to June 2019 were selected as study subjects after transcatheter closure.The children in experimental group were treated with both tramadol(1 mg/kg)and tropisetron(0.1 mg/kg)by intravenous injection,while children in control group were injected with ropivacaine(3 mg/kg)at the puncture site at the end of the transcatheter closure.Postoperative pain,bleeding or hematoma at the puncture site,ecchymosis,occluder displacement or shedding,residual shunt,hypotension,nausea and vomiting,and arrhythmia were analyzed.Results The incidence of moderate and severe pain in the experimental group was lower than that in control group(Z=8.221,P<0.001);The incidence of ecchymosis in the experimental group was lower than that in control group(χ2=6.538,P<0.05);The incidence of hematoma or hemorrhage,residual micro shunt and arrhythmia in the experimental group was lower than that in control group,but the difference was not statistically significant(P>0.05).There were no complications such as displacement or falling off of occluder,hypotension,nausea and vomiting,and pericardial tamponade in both groups.There is a positive correlation between postoperative pain and postoperative complications in children with congenital heart disease.Conclusion Tramadol combined with tropisetron have better sedative and analgesic effects than ropivacaine in children with congenital heart diseases after transcatheter closure,which is more conducive to the control of postoperative complications and improves the feeling and comfort in children after percutaneous tanscatheter closure.