舒芬太尼持续静脉镇痛对腹腔镜疝囊高扎术后婴儿应激反应的影响  

Effects of postoperative continuous intravenous analgesia with sufentanil on stress response in infants after hernia sac high ligation through laparoscopy

作　　者：胡继军[1] 卢桂娥[2] 吴江[3] 黄松甫[1] Hu Jijun Lu Guie Wu Jiang Huang Songfu(Department of Anesthesia, People＇s Hospital of Tongcheng, Hubei 437400, Chin)

机构地区：[1]湖北省通城县人民医院麻醉科,437400 [2]湖北省通城县人民医院内科 [3]武汉市妇女儿童医疗保健中心麻醉科

出　　处：《北京医学》2016年第10期1050-1053,共4页Beijing Medical Journal

摘　　要：目的观察不同剂量舒芬太尼持续静脉输注对婴儿腹腔镜疝囊高扎术后镇痛效果及应激反应的影响。方法 56例腹腔镜疝囊高扎手术的婴幼儿,随机分为A组(18例)、B组(22例)、C组(28例)、D组(16例)。手术后A组未用镇痛药物,B组以舒芬太尼0.005mg/(kg·d)持续静脉输注,C组舒芬太尼0.01 mg/(kg·d)持续静脉输注,D组舒芬太尼0.015 mg/(kg·d)持续静脉输注,术后6h、12h、24h采用FLACC进行镇痛评分,观察镇痛满意度及不良反应,同时于术前,术毕即刻、术后4h、24h检测血浆中去甲肾上腺激素(NE),肾上腺激素(E),促肾上腺皮质激素(ACTH)和皮质醇(Cor)浓度。结果术后A组镇痛效果不佳,满意率最低;B组镇痛效果稍好,满意率较高;C、D组镇痛效果佳且满意率最高,但D组有1例患儿呼吸减慢。A、B2组术后4h血浆NE、E浓度明显高于其他时间段,24h降到术前水平(P<0.05)。A组术后4h NE、E分别明显高于同时点B、C、D组,而B组同时点较C、D组明显增加(P<0.05)。A、B组术后4、24h血浆ACTH和Cor浓度明显高于其他时间段,24h除A组外降到术前水平(P<0.05)。A组术后4、24h ACTH、Cor浓度明显高于同时点B、C、D组,而B组4h Cor浓度较C、D组明显增加(P<0.05)。结论婴儿腹腔镜疝囊高扎手术后给予舒芬太尼0.01 mg/(kg·d)术后持续静脉镇痛,镇痛效果好,无呼吸抑制,很少恶心呕吐等不良反应。Objective To investigate the efficacy of postoperative continuous intravenous analgesia with sulfentail and its effects on stress response in infants after hernia sac high ligation through laparoscopy.Methods Fifty-six ASA Ⅰ-Ⅲ infants undergoing laparoscopic hernia sac high ligation surgery were randomly divided into 3 group ： group A （n=18） received normal saline, group B （n=28） received continuous iv infusion of sufentail at 0.005 mg/（kg,d）, group C （n=22） received continuous 0.01mg/（kgod） and group D （n=16） received iv infusion of sufentail at 0.015mg/（kgod）. Postoperative pain was assessed and scored at 6, 12 and 24h after operation based on FLACC criteria. Satisfactory rate of analgesia and side effects were recorded.Venous blood samples were taken before and at the immediate end of operation, at 4h and 24h after operation to determine the concentrations of NE, E, ACTH.Cor Results The percentage of satisfactory analgesia was significantly higher in group B（83%）, C（91%）and D（93%）than in group A （11%）（P〈0.05）. The plasma concentrations of NE,E at 4h after operation were significantly higher in group A and B than other time points（P〈0.05）. The concentration of NE,E returned to the baseline level 24h after operation.. The plasma concentrations of NE,E at 4h after operation were significantly higher in group A compared with group B, C andD（P〈0.05）. The plasma concentrations of NE,E at 4h after operation were significantly higher in group B compared with group C and D（P〈0.05）.There was no significant change of NE,E in groups C and D. The plasma concentrations of ACTH,Cor at 4h and 24h after operation were significantly higher in groups A and B than other time points and compared with group B, C, and D（P〈0.05）. The plasma concentration of ACTH,Cor returned to baseline level 24h after operation in group B. The plasma concentrations of ACTH,Cor at 4h after operation were significantly higher in group B compared with groups C and D. There

关 键 词：舒芬太尼 静脉镇痛 婴儿 应激反应 

分 类 号：R726.1[医药卫生—儿科]