论文部分内容阅读
目的研究不同剂量舒芬太尼对小儿先天性心脏病(先心病)术后的镇痛镇静效果。方法前瞻性选取2010年11月-2011年7月在本院小儿心脏科行手术治疗的ASD或VSD患儿84例,年龄3～144个月(平均34.2个月);体质量5.0～37.0 kg(平均13.1 kg)。将患儿随机分为3组,分别予0.02μg.kg-1.h-1(Ⅰ组)、0.03μg.kg-1.h-1(Ⅱ组)及0.04μg.kg-1.h-1(Ⅲ组)的舒芬太尼术后持续静脉泵入维持镇静镇痛,比较各组术后拔管时间、恶心呕吐发生率、用药期间临时加用咪达唑仑的发生率、拔管后因呼吸抑制二次插管的发生率,并于术后4 h、8 h、12 h、24 h、48 h记录心率(HR)、收缩压(SBP)、呼吸频率(RR)、中心静脉压(CVP)、血氧饱和度(SPO2)、Wong-Baker镇痛评分、FLACC镇痛评分及Ramsay镇静评分。结果使用舒芬太尼0.02～0.04μg.kg-1.h-1持续镇痛镇静评分结果均满意,组间差异无统计学意义(P>0.05)。术后24 hⅡ组和Ⅲ组RR高于该年龄组正常高限,其余各时间点生命体征均在正常范围。术后拔管时间比较差异无统计学意义(P>0.05)。3组恶心、呕吐发生率分别为6.7%、14.8%、22.2%,差异无统计学意义(P>0.05)。Ⅲ组较Ⅰ组单次加用咪达唑仑的发生率低,差异有统计学意义(P<0.05)。3组均无因呼吸抑制而进行二次插管。结论舒芬太尼可以安全地应用于先心病患儿术后的镇痛镇静,使用0.04μg.kg-1.h-1剂量时对疼痛治疗效果好,并且在此剂量下需要单次加用咪达唑仑对患儿进行镇静的发生率低。
Objective To study the analgesic and sedative effect of sufentanil on children with congenital heart disease (CHD) after operation. Methods A total of 84 children with ASD or VSD undergoing surgery in pediatric cardiology department from November 2010 to July 2011 were prospectively selected, ranging in age from 3 to 144 months (average 34.2 months). The body weight ranged from 5.0 to 37.0 kg (Average 13.1 kg). The children were randomly divided into three groups: 0.02μg.kg-1.h-1 (group I), 0.03μg.kg-1.h-1 (groupⅡ) and 0.04μg.kg-1.h- 1 (group Ⅲ) sufentanil continuous intravenous pump to maintain sedative and analgesic, postoperative extubation time, incidence of nausea and vomiting, the temporary addition of midazolam during the treatment period, extubation The incidence of secondary intubation was then decreased by respiration. Heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR) and central venous pressure were recorded at 4 hours, 8 hours, 12 hours, 24 hours and 48 hours after operation. Pressure (CVP), oxygen saturation (SPO2), Wong-Baker analgesia, FLACC analgesia and Ramsay sedation. Results Sufentanil 0.02 ~ 0.04μg.kg-1.h-1 sustained analgesia sedation score were satisfactory, there was no significant difference between groups (P> 0.05). At 24 h after operation, the RR of group Ⅱ and group Ⅲ was higher than the normal high limit of this age group, and the vital signs of other groups were all in the normal range. Postoperative extubation time difference was not statistically significant (P> 0.05). The incidences of nausea and vomiting in the 3 groups were 6.7%, 14.8% and 22.2%, respectively, with no significant difference (P> 0.05). The incidence of midazolam in group Ⅲ was significantly lower than that in group Ⅰ (P <0.05). All three groups had no secondary intubation due to respiratory depression. Conclusion Sufentanil can be safely applied to the postoperative analgesia and sedation of patients with congenital heart disease. The treatment with painful dose of 0.04μg.kg-1.h-1 is effective and the single dose of sufentanil Midazolam has a low incidence of sedation in children.