年龄因素对吗啡用于瑞芬太尼复合麻醉短小手术患儿恢复期镇痛效应的影响  

Effect of age factor on analgesic efficacy of morphine during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery

作　　者：王珊珊[1] 王燕婷[2] 孙瑛[2] 张马忠[2] 许文音[2] 杭燕南[3] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730 [2]上海交通大学医学院附属上海儿童医学中心麻醉科,200127 [3]上海交通大学医学院附属仁济医院麻醉科,200127

出　　处：《中华麻醉学杂志》2017年第7期807-809,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价年龄因素对吗啡用于瑞芬太尼复合麻醉短小手术患儿恢复期镇痛效应的影响.方法 择期行扁桃体切除术患儿50例,性别不限,年龄3-10岁,BMI≤30 kg/m^2,ASA分级Ⅰ或Ⅱ级.根据患儿年龄分为2组：学龄前组（3-5岁,n=30）和学龄组（6-10岁,n=20）.麻醉诱导均采用吸入8％七氟醚和静脉注射吗啡0.1 mg/kg.气管插管术后行机械通气,维持PET CO235 - 45mmHg.吸入2％-3％七氟醚,静脉输注瑞芬太尼0.2 μg·kg^-1·min^-1维持麻醉.在麻醉恢复室期间采用面部表情疼痛评分（FPS评分）和疼痛行为量表评分（FLACC评分）评估疼痛程度.当FPS评分或FLACC评分≥4分时,静脉注射吗啡0.05 mg/kg,若注射2次吗啡（间隔5 min）仍无法缓解时,改为静脉注射芬太尼1 μg/kg,直至FPS评分和FLACC评分〈4分.记录镇痛药物使用情况及其用量（芬太尼用量换算为吗啡用量）;记录恶心呕吐、瘙痒和呼吸抑制的发生情况.结果 与学龄前组比较,学龄组麻醉恢复期镇痛药物使用率及其用量降低（P〈0.05）,恶心呕吐发生率差异无统计学意义（P〉0.05）.2组未见瘙痒和呼吸抑制的发生.结论 吗啡用于瑞芬太尼复合麻醉短小手术患儿恢复期镇痛效应受年龄因素的影响,用于学龄患儿的镇痛效应优于学龄前患儿.Objective To evaluate the effect of age factor on the analgesic efficacy of morphine during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery.Methods Fifty pediatric patients of both sexes,aged 3-10 yr,with body mass index ≤ 30 kg/m^2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective tonsillectomy,were divided into preschool group （3-5 yr,n=30） and school-age group （6-10 yr,n =20） according to age.Anesthesia was induced by inhaling 8% sevoflurane and Ⅳ morphine 0.1 mg/kg.Pediatric patients were mechanically ventilated after tracheal intubation,and end-tidal pressure of carbon dioxide was maintained between 35-45 mmHg.Anesthesia was maintained by inhalation of 2%-3% sevoflurane and Ⅳ infusion of remifentanil 0.2 μg · kg^-1 · man^-1.Pain was evaluated using Faces Pain Scale （FPS） and Face Legs Activity Cry Consolability （FLACC） scale during the recovery period in the postanesthesia care unit.When FPS or FLACC scores ≥ 4.morphine 0.05 mg/kg was intravenously injected.When pain was still unrelieved after morphine was given for 2 times （time interval 5 min）,fentanyl 1 μg/kg was intravenously injected until FPS and FLACC scores 〈4.The requirement for analgesics and consumption of analgesics （fentanyl consunption was converted into morphine consumption） were recorded.The development of nausea and vomiting,pruritus and respiratory depression was also recorded.Results Compared with preschool group,the requirement for analgesics and consunption of analgesics were significantly decreased during recovery from anesthesia （P〈0.05）,and no significant change was found in the incidence of nausea and vomiting in school-age group （P〉0.05）.No pruritus or respiratory depression was found in two groups.Conclusion The analgesic efficacy of morphine is affected by age factors during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery,and morphine produces better analge

关 键 词：年龄因素 吗啡 哌啶类 儿童 镇痛 

分 类 号：R726.1[医药卫生—儿科]