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目的:比较不同剂量舒芬太尼用于小儿先天性心脏病术后镇痛的临床效果及不良反应,为舒芬太尼持续静脉应用于儿童术后镇痛提供安全有效的用药剂量依据。方法:将ASA I~II级先天性心脏病手术患儿120例,采用随机单盲对照试验分为四组:舒芬太尼1组(S1)、舒芬太尼2组(S2)、舒芬太尼3组(S3)和吗啡组(M),每组30例。S1组:舒芬太尼维持剂量0.03μg/(kg·h)+咪达唑仑2μg/(kg·min);S2组:舒芬太尼维持剂量0.04μg/(kg·h)+咪达唑仑2μg/(kg·min);S3组:舒芬太尼维持剂量0.05μg/(kg·h)+咪达唑仑2μg/(kg·min);M组:吗啡维持剂量15μg/(kg·h)+咪达唑仑2μg/(kg·min)。于术后1、4、8、12、24 h进行面部表情镇痛评分、Ramsay镇静评分,监测心率(HR)、呼吸(RR)、平均动脉压(MAP)、血糖(BS)、乳酸(Lac)、血清皮质醇(Cor),并对不良反应发生情况及临时需追加镇静药物例数进行比较。结果:与M组相比,S1、S2、S3组术后1 h镇痛、镇静满意度显著提高(P<0.05),其余各时间点各组间比较差异无统计学意义(P>0.05);M组需临时追加镇静药物例数明显增多;四组患儿在术后1 h及4 h Cor水平均显著高于正常生理水平,M组在术后1 h Cor水平较其余三组明显增高(P<0.05);四组间HR、RR、MAP、BS、Lac及术后不良反应比较差异均无统计学意义(P>0.05)。结论:舒芬太尼用于小儿先天性心脏病术后镇痛效果优于吗啡,舒芬太尼0.03~0.05μg/(kg·h)剂量范围联合咪达唑仑2μg/(kg·min)均能达到满意镇痛镇静效果,不良反应少,安全可靠,可作为小儿先天性心脏病术后镇痛、镇静理想的药物组合。
OBJECTIVE: To compare the clinical effects and side effects of sufentanil used for postoperative analgesia in children with congenital heart disease, and to provide a safe and effective dose basis for the sustained intravenous administration of sufentanil in postoperative analgesia in children. Methods: One hundred and twenty ASA children with congenital heart disease undergoing cardiac surgery were randomly divided into four groups: sufentanil group (S1), sufentanil group (S2), Shu Fentanyl group 3 (S3) and morphine group (M), 30 cases in each group. In group S1, the dose of sufentanil was 0.03μg / (kg · h) + midazolam 2μg / (kg · min); in group S2, the dose of sufentanil was 0.04μg / (kg · h) (Group A), and group A (group A). Morphine maintenance dose 15μg / (kg · min); Group S3: sufentanil maintenance dose 0.05μg / (kg · h) + midazolam 2μg / · H) + midazolam 2 μg / (kg · min). The facial expression analgesia score, Ramsay sedation score, heart rate monitor (HR), respiration (RR), mean arterial pressure (MAP), blood glucose (BS), lactate ), Serum cortisol (Cor), and the occurrence of adverse reactions and the need for additional sedation drug cases were compared. Results: Compared with M group, the satisfaction of analgesia and sedation at 1 hour after operation in S1, S2 and S3 groups were significantly increased (P <0.05), while there was no significant difference among the groups at other time points (P> 0.05) ; The number of sedation medication needed to be temporarily added in group M was significantly increased; the Cor levels at 1 h and 4 h after operation in all four groups were significantly higher than those in normal group; Cor levels in M group at 1 h after operation were significantly higher than those in the other three groups (P <0.05). There were no significant differences in HR, RR, MAP, BS, Lac and postoperative adverse reactions between the four groups (P> 0.05). Conclusion Sufentanil is superior to morphine in postoperative analgesia in children with congenital heart disease. Sufentanil dose range of 0.03 ~ 0.05μg / (kg · h) combined with midazolam 2μg / (kg · min) Can achieve satisfactory analgesic and sedation effects, less adverse reactions, safe and reliable, can be used as pediatric congenital heart disease postoperative analgesia, sedative ideal combination of drugs.