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目的观察不同剂量舒芬太尼持续静脉输注对婴儿腹腔镜疝囊高扎术后镇痛效果及应激反应的影响。方法 56例腹腔镜疝囊高扎手术的婴幼儿,随机分为A组(18例)、B组(22例)、C组(28例)、D组(16例)。手术后A组未用镇痛药物,B组以舒芬太尼0.005mg/(kg·d)持续静脉输注,C组舒芬太尼0.01 mg/(kg·d)持续静脉输注,D组舒芬太尼0.015 mg/(kg·d)持续静脉输注,术后6h、12h、24h采用FLACC进行镇痛评分,观察镇痛满意度及不良反应,同时于术前,术毕即刻、术后4h、24h检测血浆中去甲肾上腺激素(NE),肾上腺激素(E),促肾上腺皮质激素(ACTH)和皮质醇(Cor)浓度。结果术后A组镇痛效果不佳,满意率最低;B组镇痛效果稍好,满意率较高;C、D组镇痛效果佳且满意率最高,但D组有1例患儿呼吸减慢。A、B2组术后4h血浆NE、E浓度明显高于其他时间段,24h降到术前水平(P<0.05)。A组术后4h NE、E分别明显高于同时点B、C、D组,而B组同时点较C、D组明显增加(P<0.05)。A、B组术后4、24h血浆ACTH和Cor浓度明显高于其他时间段,24h除A组外降到术前水平(P<0.05)。A组术后4、24h ACTH、Cor浓度明显高于同时点B、C、D组,而B组4h Cor浓度较C、D组明显增加(P<0.05)。结论婴儿腹腔镜疝囊高扎手术后给予舒芬太尼0.01 mg/(kg·d)术后持续静脉镇痛,镇痛效果好,无呼吸抑制,很少恶心呕吐等不良反应。
Objective To observe the effects of sufentanil with different doses of continuous intravenous infusion on analgesia and stress response after laparoscopic ligation of hernia sac in infants. Methods Fifty-six infants with laparoscopic hernia sac were randomly divided into group A (n = 18), group B (n = 22), group C (n = 28) and group D (n = 16). Group A received intravenous infusion of sufentanil 0.005 mg / (kg · d), group C received intravenous infusion of sufentanil 0.01 mg / (kg · d), and group D received intravenous infusion of D Sufentanil 0.015 mg / (kg · d) continuous intravenous infusion, postoperative 6h, 12h, 24h FLACC analgesia score, analgesic satisfaction and adverse reactions observed at the same time before surgery, immediately after surgery, Plasma concentrations of norepinephrine (NE), adrenal hormone (E), adrenocorticotropic hormone (ACTH) and cortisol (Cor) were measured at 4h and 24h after operation. Results The postoperative analgesia in group A was unsatisfactory and the satisfaction rate was lowest. The analgesic effect in group B was slightly better and the satisfaction rate was higher. The analgesic effect was the highest in group C and group D, but one patient in group D resumed breathing Slow down. The plasma concentrations of NE and E in group A and B2 at 4h after operation were significantly higher than those at other time points and were reduced to preoperative levels at 24h (P <0.05). The NE and E in group A at 4 hours after operation were significantly higher than those in groups B, C and D at the same time, while those in group B at the same time were significantly higher than those at C and D (P <0.05). The concentrations of plasma ACTH and Cor in group A and B at 4 and 24 hours after operation were significantly higher than those at other time points. The levels of ACTH and Cor in group A and B after operation were lower than preoperative levels except in group A (P <0.05). At 4 and 24 hours after operation, the concentrations of ACTH and Cor in group A were significantly higher than those in groups B, C and D at 4 and 24 hours after operation. The concentrations of 4h Cor in group B were significantly higher than those in groups C and D (P <0.05). Conclusions Supamycin 0.01 mg / (kg · d) given intravenously after laparoscopic hernia sac surgery has a good analgesic effect, no analgesic effect and little nausea and vomiting.