芬太尼在学龄前小儿骨折术后镇痛中的应用  

Efficacy of Orthopedics Postoperative Pain Relief for Preschool Children with Fentanil

作　　者：安小凤[1] 方燕[1] 

机构地区：[1]解放军第98医院麻醉科,浙江省湖州市313000

出　　处：《医学理论与实践》2010年第3期264-267,共4页The Journal of Medical Theory and Practice

摘　　要：目的：探讨学龄前小儿骨科手术后使用芬太尼进行静脉镇痛的最佳剂量。方法：四肢骨折手术患儿60例,年龄3-7岁,ASA Ⅰ或Ⅱ级,随机分为3组,每组20例,均在静吸复合口插管全身麻醉下完成手术。术毕接镇痛泵：A组芬太尼5μg.kg^-1.d^-1 B组芬太尼7μg.kg-1.d-1 C组芬太尼10μg.kg^-1.d^-1,以2ml/h恒速静脉输注,观察并记录术后2、4、8、12、24、48h患儿的HR、MAP、RR、sPO2、镇痛、镇静评分、不良反应。结果：60例患儿均完成了48h术后镇痛。镇痛评分：与B组和C组比较,A组各时段评分增加（P〈0.05）,差异有统计学意义 C组与B组比较差异无统计学意义（P〉0.05）。镇静评分：与A组和B组比较,C组各时段评分增加（P〈0.05）,差异有统计学意义 B组与A组比较差异无统计学意义（P〉0.05）。HR、MAP、RR：与B组和C组比较,A组在术后2、4、8、12、24、48h均升高（P〈0.05）,差异有统计学意义。sPO2：各组差异无统计学意义（P〉0.05）。不良反应：术后恶心、呕吐、瘙痒等并发症,与A组和B组比较,C组出现不良反应的例数明显增多（P〈0.05）,差异有统计学意义。结论：芬太尼7μg.kg^-1.d^-1静脉持续输注用于学龄前小儿骨科术后镇痛效果好,不良反应少,安全可行。Objective： To investigate the optimal dosage of intravenous fentanil infusion for orthopedics postoperative analgesia in preschool children. Methods： Sixty children patients （ASA I-II, aged 3--7）scheduled to undergo orthopedics surgery under general anesthesia were randomly divided into three groups. Group A received fentanil 5μg · kg^-1· d^-1 i. v. for postoperative analgesia, group B received fentanil 7μg· kg^-1 . d^-1 i. v. , group C received fentanil 10μg · kg^-1 · d^-1 i. v. Patient-controlled intravenous pump was connected immediately at the end of operation. The infusion rate was 2 ml/h. HR, MAP, sPO2, RR, visual analogue score, sedation score and sicte effect were recorded at 2,4,8,12, 24 and 48h after operation. Results： All patients accomPlished postoperative analgesia. Visual analogue pain scores in group A was significantly higher than group B and C（P〈0. 05） ,and there was no diference between group B and C（P 〈0. 05）. Sedation score of group C was significantly higher than group A and B（P〈0.05） ,and there was no difference between group A and B（P〈0. 05）. HR,MAP.RR in group A were significantly higher than group B and C at 2,4,8, 12.24 and 48 h after operation（P〈0. 05）. No significant difference of sPO2 was found among three groups（P〈0. 05）. The incidence of postoperative nausea, vomiting and pruritus in group C was significantly higher than group A and B（P 〈0. 05）. Conclusion： Fentanil 7μg · kg^-1 ·d ^-1i. v. can be isfactory effect and less side effects. used for intravenous analgesia in preschool children with sat-isfactory effect and less side effects.

关 键 词：学龄前小儿 芬太尼 骨科 术后镇痛 

分 类 号：R619[医药卫生—外科学] R971[医药卫生—临床医学]