右美托咪定复合舒芬太尼应用于小儿快通道心脏麻醉术后镇痛的临床观察  

Clinical observation of Dexmedetomidine combined with Sufentanil in the analgesia of children after fast-track cardiac anesthesia

作　　者：彭粤 吴涯雯[2] PENG Yue;WU Ya-wen(The Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen 510000,China)

机构地区：[1]广州医科大学,510000 [2]广州医科大学附属第三医院,510030

出　　处：《中国实用医药》2018年第26期3-6,共4页China Practical Medicine

摘　　要：目的探讨右美托咪定复合舒芬太尼应用于小儿快通道心脏麻醉术后镇痛的效果及安全性。方法 100例先天性心脏病拟行外科矫治手术患儿,随机分为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组,各25例。Ⅰ组采用右美托咪定复合舒芬太尼进行术后镇痛,Ⅱ组采用舒芬太尼进行术后镇痛,Ⅲ组采用右美托咪定进行术后镇痛,Ⅳ组采用罗哌卡因局部浸润进行镇痛。比较四组的生命体征变化情况、带气管导管时间、拔管后0.5 h血气分析值及乳酸(LAC),术后镇痛、镇静效果及不良反应发生率。结果四组1、6、12、24、48 h的心率(HR)、脉搏氧饱和度(SpO_2)、平均动脉压(MAP)比较差异无统计学意义(P>0.05)。四组带气管导管时间、pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及LAC比较差异无统计学意义(P>0.05)。术后第1~3天Ⅰ组改良面部表情评分法(FLACC)评分分别为(2.34±0.47)、(2.31±0.37)、(2.12±0.36)分,Ⅱ组分别为(3.79±0.49)、(3.61±0.51)、(3.37±0.47)分,Ⅲ组分别为(3.84±0.48)、(3.80±0.44)、(3.79±0.45)分,Ⅳ组分别为(4.96±0.81)、(4.87±0.84)、(4.79±0.72)分;术后第1~3天Ⅰ组FLACC评分均低于Ⅱ、Ⅲ、Ⅳ组,差异有统计学意义(P<0.05)。术后第1~3天Ⅰ组Ramsay评分均高于Ⅱ、Ⅲ、Ⅳ组,差异有统计学意义(P<0.05)。四组患儿不良反应发生率比较差异无统计学意义(P>0.05)。结论小儿快通道心脏麻醉的基本原则为既可术后早期迅速拔管,又可确保血流动力学平稳,维持足够的麻醉深度,其中术后镇痛起到非常重要的作用,静脉自控镇痛(PCIA)使用右美托咪定复合舒芬太尼,镇痛镇静有效、安全,无明显不良反应,值得临床推广。Objective To investigate the analgesic effect and safety of Dexmedetomidine combined with Sufentanil in children after fast-track cardiac anesthesia. Methods A total of 100 children with congenital heart disease underwent surgical correction were randomly divided into group I , group Ⅱ, group Ⅲ and group IV, 25 cases in each group. Group I received Dexmedetomidine combined with Sufentanil for postoperative analgesia, group Ⅱ received Sufentanil for postoperative analgesia, group Ⅲ received Dexmedetomidine for postoperative analgesia, and group IV received local infiltration of Ropivacaine for analgesia. The changes of vital signs, time of endotracheal intubation, blood gas analysis and lactic acid （LAC） 0.5 hour after extubation, postoperative analgesia, sedation effect and incidence of adverse reactions in the four groups were compared. Results There were no significant differences in the heart rate （HR）, pulse oxygen saturation （SpO2） and mean arterial pressure （MAP） among the four groups at 1 hour, 6, 12, 24 and 48 hours after surgery （P〉0.05）. There were no significant differences in the time of endotracheal intubation, pH, arterial oxygen partial pressure （PaO2）, arterial partial pressure of carbon dioxide （PaCO2） and LAC among the four groups （P〉0.05）. The scores of modified face, legs, activity, crying, consolability （FLACC） in group I at 1st to 3rd day after surgery were （2.34±0.47） scores, （2.31±0.37） scores and （2.12±0.36） scores respectively, those in group Ⅱ were （3.79 ±0.49） scores, （3.61 ± 0.51） scores and （3.37 ±0.47） scores respectively, those in the group Ⅲ were （3.84±0.48） scores, （3.80 ±0.44） scores and （3.79 ± 0.45） scores respectively, those in the group IV were （4.96 ± 0.81） scores, （4.87 ±0.84） scores and （4.79 ± 0.72） scores respectively. The scores of FLACC in group I at 1st to 3rd day after surgery were significantly lower than those in group H, m and IV, the differences were s

关 键 词：小儿快通道心脏麻醉 术后镇痛 右美托咪定 舒芬太尼 

分 类 号：R726.1[医药卫生—儿科]