瑞芬太尼在小儿术后镇痛疗效和安全性的研究  

Analgesic efficacy and safety of remifentanil for postoperative congenital heart children

作　　者：皮丹丹[1] 刘成军[1] 李静[1] 陈应富[1] 党红星[1] 许峰[1] Pi Dandan;Liu Chengjun;Li Jing;Chen Yingfu;Dang Hongxing;Xu Feng(Department of Pediatric Intensive Care Unit, Children＇s Hospital of Chongqing Medical University, Chongqing 400014, China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,400014

出　　处：《中国小儿急救医学》2018年第3期203-207,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的比较不同剂量瑞芬太尼对先天性心脏病手术后患儿镇痛的临床疗效及安全性，为其用于儿童术后镇痛提供合适的用药参考剂量。方法采用前瞻性研究，将ASAⅠ-Ⅱ级先天性心脏病手术患儿250例随机单盲分为5组：RF1组50例予瑞芬太尼1-3 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）静脉维持；RF2组50例予瑞芬太尼3-6 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）静脉维持；RF3组50例予瑞芬太尼6-9 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）静脉维持；SF组50例予舒芬太尼0.08 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）静脉维持，M组50例予吗啡维持剂量20 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）静脉维持。于术后1 h、4 h、8 h、12 h、24 h进行面部表情疼痛评分（FPS）、Ramsay镇静评分，监测心率、平均动脉压、血糖、乳酸、血清皮质醇水平，并对不良反应发生情况、临时需追加镇静药物的例数、机械通气时间进行比较。结果（1）与M组相比，RF1组、RF2组、RF3组及SF组患儿在术后1 h、4 h镇痛满意度显著升高（P均〈0.05）；RF2组和RF3组在术后1 h、4 h、8 h时间点镇痛满意度较RF1组显著升高（P均〈0.05）。（2）与M组及SF组相比，RF1组、RF2组、RF3组在术后4 h、8 h、12 h心率及血压波动较小，血流动力学更稳定；（3）M组发生低血压及需临时追加镇静药物人次明显增多（P〈0.05），RF3组发生呼吸抑制的概率最高（P＝0.06）。（4）术后各时间点5组血糖、乳酸、血清皮质醇水平及机械通气时间均无明显差异。结论（1）瑞芬太尼及舒芬太尼用于先天性心脏病术后患儿镇痛效果优于吗啡，且瑞芬太尼血流动力学更稳定。（2）瑞芬太尼3-6 μg/（kg·h）＋咪达唑仑2 μg/（kg·min）可使术后患儿达到满意镇痛镇静效果，不良反应少，安全可靠，为小儿术后镇痛镇静的安全理想药物组合。ObjectiveTo evaluate the efficacy and safety of remifentanil（RF）for analgesia of post-operative children with congenital heart disease in pediatric intensive care unit.MethodsA total of 250 patients were enrolled and divided into 5 groups by random numerical table method.Patients in group RF1,RF2,RF3,SF and M was treated with at the doses of reminfentanil 1-3 μg/（kg·h）,3-6 μg/（kg·h）,6-9 μg/（kg·h）,sufentanil 0.08 μg/（kg·h）and morphine 20 μg/（kg·h）respectively.All the analgesias were given intravenously with midazolam 2 μg /（ kg·min）for sedative.We recorded the faces pain scale,Ramsay,vital signs（mean arterial pressure,heart rate）,blood gas analysis,cortisol,ventilation time,times of contemporary sedation drugs and incidence of side effects in 24 hours after operation（1 h,4 h,8 h,12 h,24 h）.ResultsThe analgesic satisfaction in group M were lower than those in the other four groups at 1 h,4 h（P〈0.05）,and the analgesic satisfaction in group RF3 were higher than those in group RF1 and RF2 at 1 h,4 h,8 h（P〈0.05）.Compared with group M and SF,group RF1,group RF2 and group RF3 had a more stable hemodynamics（mean arterial pressure,heart rate）.The times of contemporary sedative in group M were maximum among the 5 groups.The incidence of low blood pressure in group M was higher than those in the other four groups（P=0.06）,while the incidence of respiratory depression in group RF3 was the most（P=0.06）.There were also no significant differences in blood gas analysis,cortisol and ventilation time among each group.ConclusionThe efficacy of remifentanil is superior to morphine.Compared with sufentanil and morphine,remifentanil has less influence on hemodynamics.We recommend the dose of remifentanil 3-6 μg/（kg·h）,compound with midazolam 2 μg/（kg·min）,which is more reliable and durable.

关 键 词：瑞芬太尼 先天性心脏病 镇痛 镇静 

分 类 号：R726.1[医药卫生—儿科]