氢吗啡酮用于小儿术后静脉镇痛的随机对照研究

发布时间：2018-02-14 15:05

本文关键词： 氢吗啡酮术后镇痛静脉小儿　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究氢吗啡酮在小儿发育性髋关节脱位矫形术后静脉镇痛中的应用,评价其有效性及安全性。方法:采用随机、双盲、平行阳性对照的研究方法。纳入75例2~5岁全身麻醉下行发育性髋关节脱位矫形术的患儿,随机分为舒芬太尼组(S组)和氢吗啡酮组(H组),S组38例,H组37例。使用相同的麻醉方案。两组患儿手术结束前分别单次静脉注射舒芬太尼0.1μg/kg或氢吗啡酮10μg/kg,气管拔管后均接受术后48小时父母控制静脉镇痛治疗。S组背景剂量0.04μg·kg-1·h-1,单次冲击剂量0.01μg/kg,H组背景剂量4μg·kg-1·h-1,单次冲击剂量1ug/kg,两组镇痛泵药液均配置到100ml、输注速度为2ml/h、单次冲击剂量0.5ml、锁定时间15min、持续输注48h。通过苏醒期呛咳、躁动评分、生命体征变化,术后不同时间点疼痛评分、血清P物质、镇静评分、阿片类药物消耗量及镇痛泵的按压次数、父母满意度评分、不良反应和不良事件发生率评估其临床有效性及安全性。结果:苏醒期H组平均动脉压高于S组(P0.05),睁眼时H组Narcotrend值低于S组(P0.05),两组患儿躁动与呛咳发生率组间差异无统计学意义(P0.05),拔管时间和苏醒时间组间差异无统计学意义(P0.05);术后镇痛期H组T5、T6、T7时间点镇静效果较强,组间差异具有统计学意义(P0.05),H组无效按压次数较S组多(P0.05),有效按压次数及患儿家属满意度组间差异无统计学差异(P0.05),疼痛评分与血清P物质两组间差异无统计学意义(P0.05);两组患儿不良反应及不良事件发生率组间差异均无统计学意义(P0.05)。结论:与等效剂量舒芬太尼相比,氢吗啡酮10μg/kg手术结束前单次静脉注射有助于麻醉苏醒期平稳恢复,维持生命体征平稳。氢吗啡酮背景剂量4μg·kg-1·h-1,单次冲击剂量1μg/kg可以作为一个新的治疗选择用于小儿骨科手术后父母控制静脉镇痛,安全有效,但需注意其术后早期镇静效果可能较舒芬太尼强。
[Abstract]:Objective: to study the efficacy and safety of hydromorphone in intravenous analgesia after orthopedic surgery for developmental dislocation of the hip in children. Methods: a study of 75 children with developmental dislocation of the hip under general anesthesia at the age of 2 to 5 years was included in a parallel positive control study. They were randomly divided into sufentanil group (group S) and hydromorphine group (group H, n = 38) and group H (n = 38). The same anesthesia was used in both groups. Sufentanil (0.1 渭 g / kg) or hydromorphine (10 渭 g / kg) was injected intravenously before the end of operation in both groups. The background dose was 0.04 渭 g 路kg-1 路h-1in group S, the background dose was 4 渭 g 路kg-1 路h-1 in group H, and the dose was 1 渭 g 路kg-1 路h-1 in group H after 48 hours of parent-controlled intravenous analgesia. The analgesic pump solution in both groups was allocated to 100ml, the infusion rate was 2 ml / h, and the single impact dose was 1 渭 g 路kg-1 路h-1. The dose of 0.5 ml, locking time of 15 minutes, continuous infusion of 48 hours. Restlessness score, vital signs change, postoperative pain score at different time points, serum substance P, sedation score, opioid consumption, times of analgesic pump compression, parental satisfaction score, Results: the mean arterial pressure in group H was higher than that in group S during recovery, and the Narcotrend value in group H was lower than that in group S when eyes opened. The difference between the incidence of restlessness and choking in two groups was observed. There was no significant difference in the time of extubation and recovery between the two groups, and there was no significant difference in the time of extubation and recovery (P 0.05), and the sedative effect was stronger in group H at the time point of T5 and T6 and T7 during postoperative analgesia. There was no significant difference in the number of invalid compressions between the two groups. There was no significant difference in the number of effective compressions and the satisfaction of the children's family members (P 0.05). There was no significant difference between the two groups in pain score and substance P level in serum. There was no significant difference in the incidence of adverse reactions and adverse events between the two groups. Conclusion: compared with the equivalent dose of sufentanil, there was no significant difference in the incidence of adverse reactions and adverse events between the two groups. A single intravenous injection of hydromorphone 10 渭 g / kg before the end of the operation is helpful for the steady recovery during the anaesthesia recovery period. The background dose of hydromorphone was 4 渭 g 路kg-1 路h-1 and the single impact dose of 1 渭 g / kg could be used as a new therapeutic option for parent-controlled intravenous analgesia after orthopedic surgery in children. However, it should be noted that the early sedation effect may be stronger than sufentanil.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.1

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