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目的:探讨舒芬太尼在使用氯胺酮基础麻醉后行骨科手术的小儿患者达到适宜镇痛效果的最佳剂量。方法:将60例择期行骨科手术需术后镇痛的5~10岁患儿随机分为4组,每组15例,术前注射氯胺酮1~2 mg/kg,分别于麻醉清醒后采用病人自控镇痛技术使用舒芬太尼0.025μg/kg(S1组)、0.035μg/kg(S2组)、0.045μg/kg(S3组)和0.055μg/kg(S4组)术后镇痛。评估4组患儿在静脉镇痛后0.5 h(T1)、1 h(T2)、2 h(T3)、6 h(T4)及12 h(T5)的视觉模拟评分(VAS)、Ramsay镇静评分、需要按压镇痛泵次数及各组患儿出现的不良反应等。结果:随着舒芬太尼浓度增加,VAS评分逐渐降低,S2、S3组患儿在T2、T3及T4时间点的VAS评分比较差异无统计学意义,其余各组在相同时间点比较差异有统计学意义(P<0.05)。与S1组比较,其余各组按压镇痛泵次数减少,差异有统计学意义(P<0.05),S2、S3及S4组均能获得满意的镇痛效果。随着舒芬太尼浓度增加,Ramsay评分显著增加(P<0.05)。与S1、S2组比较,S3及S4组患儿恶心、呕吐发生率较高(P<0.05)。结论:舒芬太尼可作为使用氯胺酮基础麻醉后行骨科手术的小儿患者术后镇痛的理想静脉用药,推荐最佳剂量为0.035μg/kg。
Objective: To investigate the optimal dose of sufentanil in pediatric patients undergoing orthopedic surgery after ketamine-based anesthesia to achieve the appropriate analgesic effect. Methods: Sixty children aged 5 ~ 10 years old who needed postoperative analgesia for elective orthopedic surgery were randomly divided into 4 groups with 15 cases in each group. The patients were injected with ketamine 1 ~ 2 mg / kg before anesthesia, Postoperative analgesia with sufentanil 0.025 μg / kg (group S1), 0.035 μg / kg (group S2), 0.045 μg / kg (group S3) and 0.055 μg / kg (group S4) were used for controlled analgesia. The visual analog scale (VAS) at 0.5 h (T1), 1 h (T2), 2 h (T3), 6 h (T4) and 12 h (T5) , Need to press the number of analgesia pump and adverse reactions occurred in each group of children. Results: With the increase of sufentanil concentration, the VAS score decreased gradually. There was no significant difference in the VAS score between the two groups at the T2, T3 and T4 time points, while the other groups had the same difference at the same time point Statistical significance (P <0.05). Compared with S1 group, the number of analgesic pumps was decreased in the other groups, the difference was statistically significant (P <0.05). Satisfactory analgesic effect was obtained in S2, S3 and S4 groups. The Ramsay score increased significantly with increasing sufentanil concentration (P <0.05). Compared with S1 and S2 groups, the incidence of nausea and vomiting in S3 and S4 groups was higher (P <0.05). Conclusion: Sufentanil can be used as an ideal intravenous analgesic for postoperative analgesia in pediatric patients undergoing orthopedic surgery with ketamine. The optimal dosage is 0.035μg / kg.