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目的比较氟比洛芬酯超前镇痛复合不同剂量舒芬太尼对小儿骨盆截骨矫形术术后镇痛的效果,寻找适合小儿的术后镇痛模式。方法于我院小儿骨科选取拟于全麻下行骨盆截骨矫形术的3~10岁的先天性髋脱位病儿90例,将病儿随机分为N1、N2、N3共3组。3组切皮前均给予静脉注射氟比洛芬酯1mg/kg超前镇痛,病人自控镇痛(PCA)所用舒芬太尼的剂量分别为1.5、2.0、2.5μg/kg。PCA泵中昂丹司琼含量均为0.1mg/kg,加生理盐水至100mL。记录各组病儿在麻醉恢复室拔除气管插管时间,病儿术后2、4、8、12、24、48h的FLACC疼痛评分和Ramsay镇静评分,术后48h内PCA按压次数以及恶心、呕吐、呼吸抑制等不良反应。结果 3组病儿在恢复室的术后拔管时间差异无统计学意义(P>0.05)。FLACC评分比较,术后4、8、12h,N2组、N3组低于N1组,N3组低于N2组,差异有统计学意义(F=3.664~84.558,P<0.05);术后24、48h,N3组低于N1组,差异有统计学意义(F=4.225、8.667,P<0.05)。Ramsay评分比较,术后4、8、12h,N2组和N3组高于N1组,差异有统计学意义(F=5.367~24.996,P<0.05);术后24、48h,N3组高于N1组,差异有统计学意义(F=14.073、6.074,P<0.05)。术后48h内PCA泵按压次数,N1组13次,N2组7次,N3组3次,差异有统计学意义(χ~2=6.410,P<0.05)。N3组术后48h内恶心、呕吐发生率高于N1组和N2组,差异有统计学意义(χ~2=7.587,P<0.05)。结论氟比洛芬酯1mg/kg超前镇痛复合舒芬太尼2.0μg/kg是一种理想的小儿骨盆截骨矫形术的PCA模式。
Objective To compare the effect of topical analgesic with flurbiprofen axetil combined with sufentanil at different doses on postoperative analgesia in children with pelvic osteotomy and to find a suitable postoperative analgesia model for pediatric patients. Methods Totally 90 children with congenital hip dislocation of 3 ~ 10 years old undergoing pelvic osteotomy under general anesthesia were selected in our hospital for pediatric orthopedics. The sick children were randomly divided into three groups: N1, N2 and N3. Three groups of skin incision were given intravenous flurbiprofen axetil 1mg / kg advanced analgesia, patient-controlled analgesia (PCA) sufentanil doses were 1.5,2.0,2.5μg / kg. PCA pump in ondansetron content of 0.1mg / kg, plus saline to 100mL. The time of tracheal intubation, the time of tracheal intubation and the Ramsay sedation score of 2,4,8,12,24 and 48h after operation were recorded. The number of PCA compression within 48h after operation and the incidence of nausea and vomiting , Respiratory depression and other adverse reactions. Results There was no significant difference in the extubation time between the three groups in the recovery room (P> 0.05). FLACC score at 4, 8 and 12 h postoperatively, N2 and N3 groups were lower than N1 group and N3 group was lower than N2 group, the difference was statistically significant (F = 3.664 ~ 84.558, P <0.05) 48h, N3 group was lower than N1 group, the difference was statistically significant (F = 4.225, 8.667, P <0.05). Ramsay score at 4,8,12h after operation, the N2 and N3 groups were significantly higher than those in N1 group (F = 5.367 ~ 24.996, P <0.05); at 24 and 48 hours after operation, N3 group was higher than N1 Group, the difference was statistically significant (F = 14.073, 6.074, P <0.05). PCA pump pressure 48h after operation, N1 group 13 times, N2 group 7 times, N3 group 3 times, the difference was statistically significant (χ ~ 2 = 6.410, P <0.05). The incidence of nausea and vomiting in the N3 group was significantly higher than that in the N1 and N2 groups within 48 hours after operation (χ ~ 2 = 7.587, P <0.05). Conclusions Flurbiprofen axetil 1 mg / kg advanced analgesia combined with sufentanil 2.0 μg / kg is an ideal PCA model for pediatric pelvic osteotomy.