右美托咪定复合芬太尼在小儿鼾症术后静脉自控镇痛中的应用

发布时间：2018-03-28 08:21

本文选题：右美托咪定　切入点：芬太尼　出处：《上海医学》2015年08期

【摘要】：目的观察右美托咪定复合芬太尼患者静脉自控镇痛(PCIA)应用于小儿鼾症术后镇痛的安全性和有效性。方法行鼾症手术的患儿120例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分入芬太尼小剂量组、芬太尼大剂量组、右美托咪定+芬太尼小剂量组和右美托咪定+芬太尼大剂量组,每组30例。术后均给予PCIA:芬太尼小剂量组为芬太尼6μg/kg+恩丹西酮50μg/kg,芬太尼大剂量组为芬太尼8μg/kg+恩丹西酮50μg/kg,右美托咪定+芬太尼小剂量组为右美托咪定1.25μg/kg+芬太尼6μg/kg+恩丹西酮50μg/kg,右美托咪定+芬太尼大剂量组为右美托咪定1.25μg/kg+芬太尼8μg/kg+恩丹西酮50μg/kg,各组均加0.9%氯化钠溶液稀释至100mL;负荷量均为芬太尼1μg/kg;背景剂量为4mL/h,单次给药1mL,锁定时间为15min。观察4组患儿术后的心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)、疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分,以及不良反应的发生情况。结果各组间在术后2、4、6h的HR、SBP、DBP、RR的差异均无统计学意义(P值均0.05),SpO2均95%。芬太尼大剂量组、右美托咪定+芬太尼小剂量组、右美托咪定+芬太尼大剂量组在术后4、8h的疼痛VAS评分均显著低于芬太尼小剂量组,Ramsay镇静评分均显著高于芬太尼小剂量组(P值均0.05);右美托咪定+芬太尼小剂量组、右美托咪定+芬太尼大剂量组在术后4、8h的疼痛VAS评分均显著低于芬太尼大剂量组,Ramsay镇静评分均显著高于芬太尼大剂量组(P值均0.05);右美托咪定+芬太尼大剂量组在术后4、8h的疼痛VAS评分均显著低于右美托咪定+芬太尼小剂量组(P值均0.05),Ramsay镇静评分均显著高于右美托咪定+芬太尼小剂量组(P值均0.05);4组间在术后12、24h的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均0.05)。芬太尼大剂量组、右美托咪定+芬太尼小剂量组、右美托咪定+芬太尼大剂量组术后12h内的PCIA按压次数均显著少于芬太尼小剂量组(P值均0.05),右美托咪定+芬太尼小剂量组、右美托咪定+芬太尼大剂量组均显著少于芬太尼大剂量组(P值均0.05),右美托咪定+芬太尼大剂量组显著少于右美托咪定+芬太尼小剂量组(P0.05),4组间术后12~24h的PCIA按压次数的差异均无统计学意义(P值均0.05)。4组均未发生心动过缓、呼吸抑制和皮肤瘙痒,但右美托咪定+芬太尼大剂量组出现过度镇静现象,芬太尼小剂量组发生恶心呕吐3例,芬太尼大剂量组发生恶心呕吐6例,右美托咪定+芬太尼小剂量组和右美托咪定+芬太尼大剂量组均无恶心呕吐发生。结论右美托咪定复合小剂量芬太尼用于小儿鼾症术后PCIA的效果确切,安全可靠,且不良反应少,值得临床推广。
[Abstract]:Objective to observe the safety and efficacy of dexmetomidine combined with fentanyl for postoperative analgesia in children with snoring. They were randomly divided into fentanyl low-dose group, fentanyl high-dose group, dexmetomidine fentanyl low-dose group and dexmetomidine fentanyl high-dose group. Each group was given PCIA: fentanyl 6 渭 g/kg ondansetron 50 渭 g / kg in low dose group, fentanyl 8 渭 g/kg ondansetron 50 渭 g / kg in fentanyl high dose group, dexmetomidine 1.25 渭 g/kg fentanyl 6 渭 g/kg in low dose group. Dansetron 50 渭 g / kg, dexmetomidine 1.25 渭 g/kg fentanyl 8 渭 g/kg ondansetron 50 渭 g / kg, each group diluted to 100mL with 0.9% sodium chloride solution; loading dose of fentanyl was 1 渭 g / kg; background dose was 4 mL / h, single dose was 1 mL / kg, lock time. The HR, SBP, DBP, RRV, SPO _ 2, VAS and Ramsay sedation were observed in the four groups. Results there was no significant difference in DBP RR between the two groups at 2: 4 and 6 hours after operation (P = 0.05) and SPO _ 2 _ (95). Fentanyl group with high dose and low dose group with dexmetidine fentanyl, with high dose of fentanyl, with low dose of fentanyl, no significant difference was found between the two groups. The pain VAS scores of high dose group were significantly lower than those of fentanyl low dose group (P < 0.05), and that of dexmetidine low-dose fentanyl group were significantly higher than those of fentanyl low-dose group, and that of fentanyl low-dose group were significantly higher than those of fentanyl low-dose group. The pain VAS scores in the high-dose group were significantly lower than those in the fentanyl high-dose group at 4 h after the operation (P < 0.05), and those in the high-dose fentanyl group were significantly higher than those in the fentanyl high-dose group (P < 0.05). The pain VAS scores at 4 h after operation were significantly lower than those in the low dose group of dexmetomidine fentanyl (P < 0.05) and Ramsay sedation scores were significantly higher than those in the low dose group (n = 0.05) and the VAS scores of pain at 24 h after operation. The difference of Ramsay sedation score was not statistically significant (P = 0.05). Fentanyl high dose group, fentanyl group, fentanyl group, fentanyl high dose group, The times of PCIA compression in low dose group and high dose group were significantly lower than those in fentanyl low dose group and low dose fentanyl group, and the number of times of PCIA compression in high dose group was significantly lower than that in fentanyl small dose group, and that in dexmetomidine fentanyl low dose group was lower than that in fentanyl low dose group. The high dose group of fentanyl was significantly less than that of fentanyl group (P < 0.05), and the high dose group of fentanyl was significantly less than that of the low dose group of dexmetomidine fentanyl group (P < 0.05). There was no significant difference in the number of bradycardia between the two groups (P < 0.05 or P = 0.05 or P = 0.05), and no bradycardia was found in all the groups. Respiratory inhibition and pruritus were observed, but excessive sedation was found in the high dose group of fentanyl, nausea and vomiting in 3 cases in the low dose group, nausea and vomiting in 6 cases in the high dose group of fentanyl. There was no nausea and vomiting in low dose group and high dose group. Conclusion the effect of dexmetomidine combined with low dose fentanyl on postoperative PCIA in children with snoring is effective, safe and reliable. And the adverse reaction is few, it is worth popularizing clinically.
【作者单位】：武汉市妇女儿童医疗保健中心;
【分类号】：R726.1

【相似文献】