超前镇痛在小儿腹腔镜手术中应用观察  

Preemptive analgesia for pediatric laparoscopic surgery

作　　者：张荣[1] 刘吉平[1] 董志芳[1] 倪如飞[1] 武建[1] 刘国栋[1] 张莉[2] 

机构地区：[1]广东省佛山市妇幼保健院麻醉科,佛山528000 [2]广东省佛山市妇幼保健院外科

出　　处：《中国急救复苏与灾害医学杂志》2015年第11期1054-1057,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的观察不同超前镇痛药物用于小儿腹腔镜手术的有效性及安全性。方法采用单中心、分层、随机、双盲设计，将6个月～2岁患儿随机分为芬太尼组（F）和对照组（N），2～4岁及4～7岁患儿随机分为氟比洛芬酯组（K）、曲马多组（Q）、芬太尼组（F）和对照组（N），每组40人，手术前10min缓慢静脉注射给药，监测术前、术中、术后生命体征，观察术毕停药后患儿自主呼吸恢复时间、呼之睁眼时间、拔管时间、患儿拔管后的意识状态、上呼吸道梗阻或屏气及恶心呕吐的发生率。观察患儿苏醒期躁动情况，并比较各组术后0、4、8、24h的镇痛评分。结果没有使用镇痛药物的对照组苏醒期躁动发生率及躁动评分明显高于其他干预组，各年龄段用药组术后0h及4h疼痛评分都显著低于N组，提示术前10min应用氟比洛芬酯、曲马多、芬太尼均能有效减少苏醒期躁动并减轻术后早期疼痛。在术后8h，6个月～2岁年龄段F组疼痛评分与对照组相比差异无统计学意义，2～7岁年龄段K组的镇痛评分显著低于其余3组，而Q组、F组镇痛评分与N组相比无统计学差异。结论芬太尼和曲马多均能减轻小儿腹腔镜术后早期疼痛，但对术后晚期镇痛效果有限；而氟比洛芬酯术后镇痛维持时间长，超前镇痛效果最好。Objective To observe the efficacy and safety of different preemptive analgesia for pediatric laparoscopic surgery. Methods A single centered, stratified, randomized, double-blind clinical trial was performed. Children aged between 6 months and 2 years were randomly divided into fentanyl group （F） and control group （N）; Children aged 2-4 and 4-7 years old were randomly assigned to flurbiprofen group （K）, tramadol group （Q）, fentanyl group （F）, and control group （N）, respectively, with 40 children in each group. Vital signs were monitored during and after the surgery. Time of spontaneous breathing recovery, eyes opening upon calling, estuation, and state of consciousness after estuation, existence of upper airway obstruction, breathless, nausea and vomiting were recorded. Besides, postoperative restlessness and pain scores at 0, 4, 8, 24-hour were compared. Results Incidence of postoperative restlessness and the related score were significantly higher in control group. Pain scores were significant lower within 4 hours after surgeries in children receiving any preemptive analgesia agents regardless of age. For children aged 2-7 years in flurbiprofen group, pain scores remained lower than other three group at 8h post operation, while at the same time, for those aged 6 month to 2 yeast, pain scores became comparable between groups. Conclusion Both fentanyl and tramadol can alleviate early postoperative pain in pediatric laparoscopic surgery for a limited time frame. On the contrary, flurbiprofen can effectively reduce postoperative pain and maintain for longer time, suggesting it the best option for pediatric preemptive analgesia.

关 键 词：超前镇痛 小儿腹腔镜 曲马多 氟比洛芬酯 芬太尼 

分 类 号：R459.7[医药卫生—急诊医学]