舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响

The effect of sufentanil in postoperative analgesia in children with nephroblastoma and its influence on the immune function of children

目的探讨舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响。方法采用随机数字表法将42例肾母细胞瘤患儿分为低剂量、中剂量和高剂量组,每组14例,低剂量组、中剂量组、高剂量组患儿术后舒芬太尼镇痛剂量分别为1.0、2.5、4.0μg/kg。术后6、24、48 h,采用中文版儿童疼痛行为量表(FLACC)评估三组患儿的镇痛效果,以及不良反应发生情况;麻醉前和术后1、24、72 h,检测三组患儿免疫功能指标,包括免疫球蛋白(Ig)G、IgA、IgM。结果术后6、24、48 h,中剂量组、高剂量组患儿FLACC评分均低于低剂量组患儿,差异均有统计学意义(P﹤0.05)。术后1、24、72 h,低剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05);术后1、24 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05),但术后72 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平与麻醉前比较,差异均无统计学意义(P﹥0.05)。低剂量组患儿未发生不良反应,中剂量组患儿发生恶心1例,高剂量组患儿发生恶心5例、呕吐3例。结论2.5μg/kg的舒芬太尼在肾母细胞瘤患儿术后镇痛中效果明显,且对患儿的免疫系统发挥一定的保护作用,可以减轻患儿术后免疫功能抑制。

Objective To explore the effect of sufentanil in postoperative analgesia in children with nephroblastoma and its influence on the immune function of children.Method Using random number table method,42 children with nephroblastoma were divided into low-dose,medium-dose and high-dose groups,each with 14 cases.The postoperative analgesic doses of sufentanil in the low-dose group,middle-dose group and high-dose group were 1.0,2.5,and 4.0μg/kg,respectively.At 6,24 and 48 hours after operation,the face,legs,activity,cry,consolability behavioral tool(FLACC)was used to evaluate the analgesic effect and adverse reactions of the three groups.Before anesthesia and 1,24,72 hours after operation,the immune function indexes including IgG,IgA,IgM were detected.Result At 6,24,and 48 h after operation,the FLACC scores of the children in the medium-dose group and the high-dose group were lower than those in the low-dose group,and the differences were statistically significant(P<0.05).At 1,24,and 72 h after surgery,the levels of IgG,IgA,and IgM in the low-dose group were lower than those before anesthesia in this group,and the differences were statistically significant(P<0.05).At 1,24 h after operation,the levels of IgG,IgA,and IgM in the middle-dose and high-dose groups were lower than those before anesthesia in this group,and the differences were statistically significant(P<0.05).However,72 h after the operation,there was no significant difference in the levels of IgG,IgA,and IgM between the middle-dose group and the high-dose group before anesthesia(P>0.05).There were no adverse reactions in children in the low-dose group,1 case in the middle-dose group,5 cases in the high-dose group,and 3 cases in vomiting.Conclusion Sufentanil at 2.5μg/kg is effective in postoperative analgesia in children with Wilms tumor,and it can protect the immune system of the children to a certain extent,which can reduce the suppression of immune function in children after surgery.