舒芬太尼应用于小儿术后镇痛疗效和安全性的研究

发布时间：2018-03-18 15:55

本文选题：舒芬太尼　切入点：吗啡　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本研究旨在比较不同剂量舒芬太尼和吗啡对先天性心脏病手术后镇痛的临床效果及不良反应，为舒芬太尼广泛用于幼儿术后镇痛提供合适的用药依据。方法：前瞻性研究，选取重庆医科大学附属儿童医院心胸外科2011年11月至2012年3月期间在体外循环+全身麻醉下完成的ASAI-II级120例先天性心脏病手术患者，采用单盲方法随机分为4组，舒芬太尼1组（S1），舒芬太尼2组（S2），舒芬太尼3组（S3），吗啡组（M），每组30例。术后入重症监护室连接镇痛泵开始持续镇痛，S1组给予舒芬太尼维持剂量0.03g·kg-1·h-1+咪达唑伦2g·kg-1·min-1；S2组给予舒芬太尼维持剂量0.04g·kg-1·h-1+咪达唑伦2g·kg-1·min-1；S3组给予舒芬太尼维持剂量0.05g·kg-1·h-1+咪达唑伦2g·kg-1·min-1；M组给予吗啡维持剂量15g·kg-1·h-1+咪达唑伦2g-1·kg-1·min-1。于术后1，4，8，12，24h进行面部表情疼痛评分、Ramsay镇静评分，持续监测心率(heartrate,HR)、平均动脉压(mean arterial pressure,MAP)、血糖(bloodsuger,BS)、血乳酸(lactate concentration,Lac)、血清皮质醇(cortisol,Cor)的含量，并对各组出现恶心、呕吐、皮疹的不良反应次数及临时追加咪达唑仑镇静药物的次数进行观察和比较。统计学处理：计量资料以均数±标准差表示，组间计量资料比较采用单因素方差分析，计数资料采用卡方检验，P＜0.05为差异有统计学意义。采用GraphPad Prism5程序绘制图表并比较。结果：与M组相比，S1、S2、S3组在术后1h镇痛、镇静满意度显著升高，其余各时点4组无明显差异；M组需临时追加镇静药物人次明显增多；4组患儿在术后1h及4h血清皮质醇水平均显著高于正常生理水平（p＜0.05），M组在术后1h点血清皮质醇较其余3组明显增高；4组间HR、RR、MAP、BS、Lac及术后不良反应均无明显差异。结论：舒芬太尼用于先天性心脏病术后患儿镇痛效果优于吗啡，舒芬太尼0.03g·kg-1·h-1至0.05g·kg-1·h-1剂量范围复合咪达唑仑2g·kg-1·min-1均能达到满意镇痛效果。舒芬太尼0.05g·kg-1·h-1复合咪达唑仑2g·kg-1·min-1不良反应少，需临时需追加镇静药物少，为小儿术后镇静的安全理想药物组合。
[Abstract]:Objective: to compare the clinical effects and adverse reactions of different doses of sufentanil and morphine on postoperative analgesia of congenital heart disease. Methods: a prospective study was conducted on 120 patients with ASAI-II grade congenital heart disease who underwent cardiothoracic surgery under general anesthesia under cardiopulmonary bypass from November 2011 to March 2012 in the Children's Hospital affiliated to Chongqing Medical University. A single blind method was used to divide into 4 groups at random. Sufentanil, sufentanil, sufentanil, sufentanil, sufentanil, sufentanil, and morphine, 30 patients in each group, respectively. The group S 1 was given sufentanil at a maintenance dose of 0.03 g 路kg-1 路h -1 midazolone 2 g 路kg-1 路min -1 after operation. The maintenance dose of sufentanil was 0.04g 路kg-1 路h-1 midazolam 2g 路kg-1 路min-1C S3. The maintenance dose of sufentanil was 0.05g 路kg-1 路h-1 midazolone 2g 路kg-1 路min-1. The morphine maintenance dose was 15g 路kg-1 路h-1 midazolam 2g-1 路kg-1 路min-1. Continuous monitoring of heart rate and heart rate, mean arterial pressure, mean arterial pressure MAPP, blood sugar and blood sugersBSU, lactate lactate concentration, serum cortisol, and nausea and vomiting in each group. The number of adverse reactions of skin rash and the times of temporary addition of midazolam sedation were observed and compared. Statistical analysis: the metrological data were expressed as mean 卤standard deviation, and the measurement data were compared by single factor ANOVA. There was significant difference in counting data by chi-square test (P < 0. 05). The chart was drawn by GraphPad Prism5 program and compared. Results: compared with M group, the analgesia and sedation satisfaction were significantly increased in group S _ 1 and S _ 2 + S _ 3 at 1 h after operation. There was no significant difference among the other four groups at other time points. The need for temporary sedation in group M was significantly increased. The serum cortisol levels in group 4 were significantly higher than those in normal physiological level at 1 h and 4 h after operation, p < 0. 05 and P < 0. 05 respectively. At 1 h after operation, the levels of serum cortisol in group M were significantly higher than those in group 1. There was no significant difference between the other three groups in HRN RRN MAPP BSU Lac and postoperative adverse reactions. Conclusion: the analgesic effect of sufentanil in postoperative children with congenital heart disease is better than that of morphine. The analgesic effect of sufentanil 0.03g 路kg-1 路h-1 to 0.05g 路kg-1 路h-1 combined with midazolam 2g 路kg-1 路min-1 can achieve satisfactory analgesic effect, sufentanil 0.05g 路kg-1 路h-1 combined with midazolam 2g 路kg-1 路min-1 has less adverse reactions. It is a safe and ideal combination of sedation for pediatric postoperative sedation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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