舒芬太尼超前镇痛（PCIA）对小儿扁桃体手术围拔管期的影响

发布时间：2018-03-15 01:36

  本文选题：舒芬太尼　切入点：超前镇痛　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:将舒芬太尼术后镇痛泵(patient-controlled intravenous analgesia,PCIA)超前应用在行扁桃体(或联合腺样体)切除术的患儿中,观察其在苏醒期及术后48h内的临床效果及不良反应,同时与在手术结束时开始应用舒芬太尼镇痛泵相比较,以探求维持小儿扁桃体(或联合腺样体)切除术围拔管期稳定的有效方法。方法:拟选择在我院择期行扁桃体(或联合腺样体)切除术的患儿60例,ASA I~II,随机分为实验组和对照组,每组各30例。两组患儿均接受全身麻醉。麻醉前准备,麻醉诱导以及麻醉维持均相同。术中连续监测患儿无创血压(Non-invasive blood pressure,NIBP),心电图(Electrocardiogram,ECG),心率(Heart rate,HR),脉搏血氧饱和度(Oxyhemoglobin Saturation by Pulse Oximetry,Sp O2),呼气末二氧化碳分压(Partial Pressure of End-tidal Carbon Dioxide,PETCO2)和脑电双频谱指数(Bispectral Index,BIS)。实验组(A组):手术结束前15min连接镇痛泵进行超前镇痛;对照组(B组):手术结束时连接镇痛泵进行术后镇痛。镇痛泵中均加入舒芬太尼50ug和雷莫司琼0.3mg用生理盐水稀释至100ml,设置背景速度为2ml/h,每次追加剂量为0.5ml,追加最小间隔时间为15min。两组镇痛泵均在使用48h后撤除。记录入室时刻(T1)、拔管时刻(T2)、拔管后5min(T3)、拔管后10min(T4)、拔管后15min(T5)各时间点的MAP、HR、Sp O2;记录手术时间(t1)、拔管时间(t2)以及出PACU的时间(t3)。观察并记录拔管后5min、10min、15min的PAED躁动评分、Ramsay镇静评分及FLACC评分;观察并记录术后4h、8h、24h、36h VAS评分以及Ramsay镇静评分;观察发生恶心、呕吐、呼吸抑制、嗜睡和皮肤瘙痒等不良反应的患者例数。结果:1、患者一般情况的比较:两组患儿的年龄、身高、体重、手术时间相比差异无统计学意义;2、血流动力学的比较:2.1组间比较:两组患者各时间点的MAP、HR、Sp O2差异无统计学意义。2.2组内比较:MAP、HR在拔管时(T2)明显高于其他时间点(T1、T3、T4、T5),差异有显著性(P0.05);拔管后三个时间点(T3、T4、T5)两两之间无显著性差异;但拔管后的三个时间点(T3、T4、T5)与入室时(T1)相比,低于入室水平。Sp O2在拔管时(T2)低于其他时间点T1、T3、T4、T5),有显著性差异(P0.05),其他时间点之间无显著性差异;3、苏醒指标的比较:两组患儿的拔管时间和出PACU的时间差异无统计学意义;4、苏醒期躁动和镇静评分比较:两组患儿苏醒期躁动PAED评分、Ramsay镇静评分及FLACC评分差异有统计学意义(P0.05)。A组PAED评分、FLACC评分在T3、T4、T5低于B组;A组Ramsay镇静评分在T3、T4、T5高于B组;5、术后镇痛以及镇静效果比较:术后4h、8h、24h、36h VAS评分以及Ramsay镇静评分差异无统计学意义;6、发生不良反应的比较:A、B两组患者恶心、呕吐、呼吸抑制、嗜睡、皮肤瘙痒发生率差异无统计学意义。结论:1.舒芬太尼PCIA的超前镇痛和正常术后镇痛在小儿扁桃体(或联合腺样体)切除手术后起到同样的镇静镇痛作用;2.扁桃体(或联合腺样体)切除手术中,接受舒芬太尼PCIA超前镇痛的小儿围拔管期更稳定。
[Abstract]:Objective: the postoperative sufentanil analgesia pump (patient-controlled intravenous analgesia, PCIA) in the application of advanced tonsillar (or combined adenoidectomy) resection in children, the clinical effects and adverse reactions were observed in the recovery period and within 48h after the operation, and at the same time started at the end of the operation application of sufentanil analgesia compared to to maintain the tonsillectomy (or combined adenoidectomy) effective method for resection of the extubation period stable. Methods: selected in our hospital undergoing tonsillectomy (or combined adenoidectomy) in 60 cases, resection of the children with ASA I~II, were randomly divided into experimental group and control group, 30 cases in each group. Two group the patients received general anesthesia. Preoperative preparation, anesthesia induced and maintained the same. Intraoperative continuous monitoring with non-invasive blood pressure (Non-invasive blood, pressure, NIBP), electrocardiogram (Electrocardiogram, ECG), heart rate (Heart, rate, HR), pulse Pulse oxygen saturation (Oxyhemoglobin Saturation by Pulse Oximetry, Sp O2), PetCO2 (Partial Pressure of End-tidal Carbon Dioxide, PETCO2) and bispectral index (Bispectral, Index, BIS). The experimental group (A group): the end of surgery for preemptive analgesia analgesia pump in 15min; the control group (B at the end of surgery group): analgesia for postoperative analgesia pump. The analgesia pump was added sufentanil 50ug and ramosetron 0.3mg diluted with normal saline to 100ml, set the background velocity is 2ml/h, each additional dose is 0.5ml, an additional minimum time interval for the 15min. two group were removed in the use of analgesia pump after 48h recorded before. Time (T1), extubation time (T2), 5min after extubation (T3), 10min after extubation (T4), 15min after extubation (T5) at different time points MAP, HR, Sp, O2; recording operation time (T1), extubation time (T2) and PACU time (T3) were observed and recorded. 鎷旂�″悾�

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