舒芬太尼不同自控剂量对儿科术后镇痛有效性和安全性的比较

The effectiveness and safety of different self‑control doses of sufentanil for postoperative analgesia in children

目的比较1~7岁患儿术后使用舒芬太尼行患者自控静脉镇痛(patients control intravenous analgesia,PCIA)时不同自控给药剂量的有效性和安全性。方法全身麻醉下行择期手术的患儿术后使用舒芬太尼行PCIA,舒芬太尼总量为2μg/kg,使用0.9%氯化钠稀释至100 ml,背景剂量为2 ml/h,即舒芬太尼0.04μg·kg^(−1)·h^(−1),锁定时间为15 min。采用随机数字表法将患儿分为PCIA1组(术后镇痛泵单次按压的舒芬太尼剂量为0.02μg/kg)和PCIA2组(术后镇痛泵单次按压的舒芬太尼剂量为0.01μg/kg)。分别在术后0.5 h(T_(0.5))、术后1 h(T_(1))、术后2 h(T_(2))、术后6 h(T_(6))、术后12 h(T_(12))、术后24 h(T_(24))、术后48 h(T_(48))记录患者FLACC(Face、Legs、Activity、Cry、Consolability)镇痛评分、Ramsay镇静评分、实际按压次数、有效按压次数、追加药量。记录患者恶心、呕吐、皮肤瘙痒、过度镇静和呼吸抑制等不良反应发生情况。结果PCIA1组T_(0.5)、T_(1)、T_(2)时FLACC镇痛评分低于PCIA2组(P<0.05),Ramsay镇静评分高于PCIA2组(P<0.05),镇静适度的人数比例高于PCIA2组(P<0.05);PCIA1组总按压有效率和追加总药量大于PCIA2组(P<0.05),T_(0.5)时按压有效率和T_(1)、T_(2)时实际按压次数小于PCIA2组(P<0.05),PCIA1组T_(1)2、T_(2)4时追加药物量大于PCIA2组(P<0.05);两组患儿不良反应发生情况差异无统计学意义(P>0.05)。结论对1~7岁择期手术患儿使用PCIA持续泵注舒芬太尼0.04μg·kg^(−1)·h^(−1)时,0.02μg/kg单次自控给药剂量较0.01μg/kg镇痛镇静效果更佳,并不增加不良反应发生率。

Objective To compare the effectiveness and safety of different self‑control doses of sufentanil for postoperative patients control intravenous analgesia(PCIA)in patients aged 1‒7 years.Methods Children who were scheduled for surgery under general anesthesia received PCIA,with a total amount of sufentanil of 2μg/kg which was diluted with 0.9%sodium chloride to 100 ml,a background dose of 2 ml/h(0.04μg·kg^(−1)·h^(−1) sufentanil),and a locking interval of 15 min.According to the random number table method,the patients were divided into two groups:group PCIA1(where the single self‑control dose of sufentanil was 0.02μg/kg)and group PCIA2(where the single self‑control dose of sufentanil was 0.01μg/kg).Their Face,Legs,Activity,Cry,Consolability(FLACC)analgesia scores,Ramsay sedation scores,the actual number of compression,the number of effective compression,and rescue doses were recorded 0.5 h(T_(0.5)),1 h(T_(1)),2 h(T_(2)),6 h(T_(6)),12 h(T_(12)),24 h(T_(24))and 48 h(T_(48))after surgery.The adverse reactions,including nausea,vomiting,itchy skin,hypersedation and respiratory depression were recorded.Results At T_(0.5),T_(1),and T_(2),group PCIA1 presented lower FLACC,higher Ramsay scores,and a higher proportion of moderate sedation than group PCIA2(P<0.05).Group PCIA1 presented increases in the total rate of effective compression and total rescue dose,decreases in the rate of effective compression at T_(0.5) and the actual number of compression at T_(1) and T_(2),and increases in rescue dose T_(1)2 and T_(2)4,compared with group PCIA2(P<0.05).No statistical difference was found in adverse reactions between the two groups(P>0.05).Conclusions For patients aged 1‒7 years who are scheduled for surgery and receive PCIA with sufentanil at 0.04μg·kg^(−1)·h^(−1),a single controlled dose of 0.02μg/kg is superior to 0.01μg/kg,which produces better analgesic and sedative effects without changes in the incidence of adverse reactions.