多模式镇痛在患儿非气管插管静脉麻醉中的应用  

Application of multi-mode analgesia in pediatric non-tracheal intubation intravenous anesthesia

作　　者：邓军[1] 赵兰花[2] 李明良[1] 韦克[1] 左朝晖[1] 刘俊福[1] 黄仕英[1] Deng Jun;Zhao Lanhua;Li Mingliang;Wei Ke;Zuo Chaohui;Liu Junfu;Huang Shiying(Department of Anesthesiology,Affiliated of Hospital for Youjiang Medical University for Nationalities,Baise Guangxi 533000;Department of Obstetrics,the Maternity ＆ Children’s Healthcare Hospital of Baise,Baise Guangxi,533000)

机构地区：[1]右江民族医学院附属医院麻醉科,广西百色533000 [2]广西百色市妇幼保健院产科,广西百色533000

出　　处：《医学食疗与健康》2018年第7期223-226,共4页Medical Diet and Health

摘　　要：目的探讨多模式镇痛在患儿非气管插管静脉麻醉中的应用.方法：100 例行择期手术患儿随机分 4 组.4 组患儿术中应用芬太尼或芬太尼分别复合氯胺酮、 曲马多以及布托啡诺, 术后均送复苏室复苏. 监测术中不同时间心率（HR）、 脉搏氧饱和度 （SPO2）、呼吸频率（RR）、复苏期 FLACC 评分、Ramsay镇静评分、术中芬太尼用量以及复苏时间.观察术中和复苏期呼吸抑制情况.结果：T2 至 T5 时,其余 3 组 HR、SPO2 和 RR分别高于同时段芬太尼组（F 组）（P〈0.05）.术中 F组气管插管例数和放置口咽通气道例数均高于其余 3 组,复苏期 F 组托下颌例数和放置口咽通气道例数均高于其余 3 组（P 〈0.05）.F 组患儿术中芬太尼用量高于其它 3 组（P 〈0.05）.F组患儿复苏所需要时间长于其它 3 组患儿（P 〈0.05）.结论：多模式镇痛在轻度镇静和呼吸抑制下产生更强的镇痛作用,能减少芬太尼用量和对心率的抑制,降低患儿术中脑和外周器官缺血缺氧风险,缩短复苏时间,有利于患儿快速康复.】ObjectiveTo explore the application of multi-mode analgesia in pediatric non-tracheal intubation intravenous anesthesia. Method：100 children undergone elective surgery were randomly divided into 4 groups. Fentanyl or fentanyl combined with ketamine, tramadol and butofenol were respectively applied in 4 groups pediatric patients. Heart rate （HR）, pulse oxygen saturation （SPO2）, respiratory rate （RR） were monitored at differently intra-operative times FLACC score in resuscitation period, Ramsay sedation score in resuscitation period, intra-operative fentanyl dosage and resuscitation time were also recorded. Respiratory inhibition condition during surgery and resuscitation period was observed. Results：From T2 to T5, HR, SPO2 and RR in other three group were higher than fentanyl group （group F） （P 〈0.05）.During the surgery, the cases of tracheal intubation and the cases of place oropharynx airway in group F were higher than in other three groups. During the resuscitation, the cases of mandibular lift maneuver or place oropharyngeal airway cases in group F were higher than in other three groups （P 〈0.05）.The intraoperative fentanyl dosage in group F was higher than in other 3 groups （P 〈0.05）. The resuscitation time of group F was longer than of the other 3 groups （P 〈0.05）.Conclusion： Multimode analgesia had more strong analgesic effect under mild sedation and respiratory inhibition. It could reduce the dosage of fentanyl and heart rate inhibition. It could also decrease the risk of intra-operative cerebral and peripheral organ ischemia or hypoxia. The resuscitation time was shorten by multi-mode analgesia. It could lead to the postoperative pediatric rapid recovery.

关 键 词：多模式镇痛 患儿 非气管插管静脉麻醉 呼吸抑制 快速康复 

分 类 号：R73[医药卫生—肿瘤] R5[医药卫生—临床医学]