酮咯酸氨丁三醇复合舒芬太尼对骨科手术患儿术后镇痛的临床效果

Clinical effect of Ketorolac Traminotriol combined with Sufentanil on postoperative analgesia in children undergoing orthopedic surgery

目的探讨酮咯酸氨丁三醇复合舒芬太尼对骨科手术患儿术后镇痛的临床效果。方法选取2017年4月至2019年4月赣州市中医院收治的60例全麻下行骨折复位手术患儿为研究对象。采用随机数字表法分为观察组和对照组,每组30例。对照组使用舒芬太尼进行镇痛,观察组采用酮咯酸氨丁三醇复合舒芬太尼进行镇痛。比较两组不同时间点舒芬太尼剂量、镇痛泵按压次数、CRIES评分、5-羟色胺(5-HT)水平、P物质(PS)水平及不良反应发生情况。结果两组组内术后4、8、24 h的舒芬太尼剂量呈递增趋势,术后4、8 h镇痛泵按压次数多于术后1 h,术后24 h镇痛泵按压次数少于术后1、4、8 h,差异有统计学意义(P<0.05);观察组术后1、4、8、24 h的舒芬太尼剂量和按压次数均低于对照组,差异有统计学意义(P<0.05)。两组组内术后4、8、24 h的CRIES评分呈递减趋势,两组术后1 h CRIES评分比较,差异无统计学意义(P>0.05),观察组术后4、8、24 h的CRIES评分低于对照组,差异有统计学意义(P<0.05)。两组术后2 d的5-HT、PS水平均高于术后1 d,术后3 d高于术后1、2 d,差异有统计学意义(P<0.05);观察组术后1、2、3 d的5-HT、PS水平均低于对照组,差异有统计学意义(P<0.05)。两组术后不良反应总发生率比较,差异无统计学意义(P>0.05)。结论酮咯酸氨丁三醇复合舒芬太尼用于患儿骨科手术,镇痛效果好,抑制5-HT、PS浓度的升高,安全性高。

Objective To investigate the clinical effect of Ketorolac Traminotriol combined with Sufentanil on postoperative analgesia in children undergoing orthopedic surgery.Methods A total of 60 children undergoing fracture reduction under general anesthesia in Ganzhou Hospital of Traditional Chinese Medicine from April 2017 to April 2019 were selected as the research objects.The patients were divided into observation group and control group by random number table method,30 cases in each group.The control group was treated with Sufentanil for analgesia,and the observation group was treated with Ketorolac Traminotriol combined with Sufentanil for analgesia.Sufentanil dosage,press times,CRIES score,5-hydroxytryptamine(5-HT)level,substance P(PS)level and adverse reactions were compared between the two groups at different time points.Results The dose of Sufentanil at 4,8 and 24 h after operation showed an increasing trend in both groups,the number of analgesic pump compressions at 4 and 8 h after surgery was more than 1 h after surgery,and the number of analgesic pump compressions at 24 h after surgery was less than 1,4 and 8 h after surgery,the differences were statistically significant(P<0.05).The dose and pressing times of Sufentanil in the observation group were lower than those in the control group at 1,4,8 and 24 h after operation,the differences were statistically significant(P<0.05).At 4,8 and 24 h after surgery,the scores of the two groups decreased.There was no significant difference between the two groups at 1 h after surgery(P>0.05).The CRIES of the observation group were lower than those of the control group at 4,8 and 24 h after surgery,the differences were statistically significant(P<0.05).The levels of 5-HT and PS in both groups were higher on postoperative day 2 than postoperative day 1,and higher on postoperative day 3 than postoperative day 1 and 2,the differences were statistically significant(P<0.05).The levels of 5-HT and PS in the observation group were lower than those in the control group on day 1,2 and 3 after operation,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Ketorolac Tromethamine combined with Sufentanil for pediatric orthopedic surgery has good analgesic effect,inhibits the increase of 5-HT and PS concentration,and has high safety.