吗啡与芬太尼对小儿心脏术后镇痛疗效的比较  

Comparison of morphine and fentanyl used to PCIA after children＇ s cardiac operations

作　　者：王萍[1] 谭武菊[1] 徐艳冰[1] 

机构地区：[1]山东省立医院麻醉科,济南250021

出　　处：《中国行为医学科学》2007年第11期984-985,共2页Chinese Journal of Behavioral Medical Science

摘　　要：目的探讨芬太尼与吗啡用于小儿心脏术后自控静脉镇痛（PCIA）的最佳可行性方案。方法42例择期行先心病矫治术的患儿随机分为2组：吗啡组21例,术后采用吗啡1.0mg·kg^-1镇痛;芬太尼组21例,术后采用芬太尼0.01mg·kg^-1镇痛。均稀释到100ml,镇痛治疗时间为50h。术毕回重症监护治疗室,当患儿睁眼时,开启PCIA泵。术后于4,12,24,48h记录2组的循环呼吸变化,疼痛评分和不良反应发生率。结果生理疼痛评分吗啡组[分别为（2.19±1.4）分,（3.41±1.5）分,（3.44±1.4）分,（2.07±1.3）分],芬太尼组[分别为（2.06±1.3）分,（2.98±1.1）分,（3.05±1.4）分,（1.96±1.0）分],2组间差异无显著性（P〉0.05）;2组镇痛效果构成比差异无显著性（P〉0.05）;不良反应的发生率吗啡组高于芬太尼组,但组间比较差异无显著性（P〉0.05）;2组间平均动脉压、心率、呼吸频率、脉搏血氧饱和度差异无显著性。结论芬太尼0.2μg·kg-1·h-1行小儿心外科术后镇痛,可获与吗啡20μg·kg-1·h^-1剂量下相似高质量镇痛效果,且不良反应发生率低。Objective To explore the best project of morphine and fentanyl which used to PCIA after children＇ s cardiac operations. Methods Forty-two children who accepted heart correction were allocated randomly to morphine group （M group） and fentanyl group（ F group） ： twenty-one case in M group, 1.0 mg· kg^-1· morphine was used to ease pain;twenty-one case in F group,0. 01 mg· kg^-1 fentanyl was used to ease pain. Medication was diluted to 100 ml , and last using for 50 hours. Delivered children to ICU after operations, and opened PCIA pump when they opened eyes. At 4,12,24,48 hours after operations, recorded the change of two groups of the circle and breath ,grading of pain and ratio of bad reaction. Results On children＇ s physiological pain scale , M group respectively was （ 2.19±1.4） , （ 3.41 ± 1.5 ） , （ 3.44 ±1.4 ） , （ 2.07±1.3 ） ; F group respectively was （ 2.06 ±1.3 ） , （ 2.98 ±1.1 ） , （ 3.05 ± 1.4 ） , （ 1.96 ±1.0）. There was no notable difference between two groups （ P〉0. 05 ）. No notable difference between two groups on ratio of analgesic effect（ P〉0. 05 ）. M group was higher than F group at the ratio of bad reaction, but no notable difference （ P 〉 0. 05 ）. There were no notable difference of MAP, HR, RR, SpO2 between two groups （ P 〉 0. 05 ）. Conclusion Fentanyl 0. 2μg ·kg ^- 1 · h^ - 1 was well used to ease pain after children＇ s cardiac operations as morphine 20μg· kg^-1 · h^-1, and was lower than the latter at the ratio of bad reaction. So fentanyl could replace morphine to PCIA after children＇ s cardiac operations.

关 键 词：芬太尼 吗啡 自控静脉镇痛 小儿 心外科 

分 类 号：R686[医药卫生—骨科学]