低剂量丁丙诺啡对小儿全麻下腹腔镜疝气修补术后镇痛作用观察  

Analgesia effect of small amount of buprenorphine on children undergoing laparoscopic hernia repair under general anesthesia

作　　者：应海峰 张伟萍[1] 尤匡掌[1] 陈玲阳[1] YING Haifeng, ZHANG Weiping, YOU Kuangzhang, CHEN Lingyang(Department of Anesthesiology, Zhejiang Taizhou Hospital, Linhai 317000, Zhejiang , China)

机构地区：[1]浙江省台州医院麻醉科

出　　处：《中国临床药理学与治疗学》2018年第8期916-921,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省卫计委医药卫生科技计划(2017KY162)

摘　　要：目的:探讨少量丁丙诺啡对小儿全麻下腹腔镜疝气修补术后镇痛作用。方法:选取我院麻醉科自2016年1月至2017年6月全麻腹腔镜下行疝气手术患儿62例,随机分为对照组和研究组,各31例,研究组于麻醉诱导时静脉输注丁丙诺啡3.0μg/kg,对照组于麻醉诱导时静脉输注等容量生理盐水,于丁丙诺啡输注前(T_0)、术后6 h(T_1)、术后12 h(T_2)、术后24 h(T_3)时采血测定炎症因子、免疫功能指标,观察并记录术后6 h(T_1)、术后12 h(T_2)、术后24 h(T_3)的疼痛与镇静评分,同时对比临床相应指标及躁动分级程度。结果:相对于T_0,对照组T_1、T_2、T_3时血清C反应蛋白(CRP)、TNF-α、皮质醇(Cor)含量升高,CD_4^+、CD_8^+、CD_4^+/CD_8^+含量降低,研究组T_1、T_2时血清CRP、TNF-α、Cor含量升高,CD_4^+、CD_8^+、CD_4^+/CD_8^+含量降低(P<0.05);相对于对照组,研究组T_1、T_2、T_3时血清CRP、TNF-α、Cor含量较低,CD_4^+、CD_8^+、CD_4^+/CD_8^+含量较高(P<0.05);相对于T_1,对照组T_2、T_3时镇静评分降低,研究组T_2、T_3时疼痛与镇静评分降低(P<0.05);相对于对照组,研究组T_2、T_3时疼痛与镇静评分较低(P<0.05);研究组呛咳反应、躁动评分低于对照组,躁动分级程度优于对照组(P<0.05)。结论:少量丁丙诺啡对小儿全麻下腹腔镜疝气修补术后具有良好的镇痛、镇静作用,可以降低炎症指标,提高免疫功能。AIM： To investigate the analgesia effect of small amount of buprenorphine on children undergoing laparoscopic hernia repair under general anesthesia. METHODS： From January 2016 to June 2017, sixty-two children undergoing laparoscopic hernia operation under general anesthesia in our hospital were randomly divided into control group and study group,with 31 cases in each group. The study group received buprenorphine 3 μg/kg on the induction of anesthesia,and the control group received equal amount of saline. Inflammatory cytokines,immune function were detected at Pre infusion（T0）,postoperative 6 h（T1）,12 h（T2）,and 24 h（T3）,and pain and sedation scores as well as the clinical index and agitation classification were observed and compared after the operation.RESULTS： Compared with T0, levels of serum CRP,TNF-α and Cor in the control group increased at T1,T2,and T3; levels of CD4^＋,CD8^＋,CD4^＋/CD8^＋ decreased; levels of serum CRP,TNF-α and Cor in the study group increased at T2,and T3; levels of CD4^＋,CD8^＋,CD4^＋/CD8^＋ decreased（P〈0.05）. Compared with the control group,levels of serum CRP,TNF-α and Cor in the study group at T1,T2,and T3 were lower; levels of CD4^＋,CD8^＋,CD4^＋/CD8^＋ were higher（P〈0.05）. Compared with T1,RASS scores in the control group decreased at T2 and T3; pain scores and RASS scores in the study group decreased at T2,T3. Compared with the control group,pain scores and RASS scores in the study group at T2,T3 were lower（P〈0.05）,the cough response and agitation scores in the study group were lower than those of the control group（P〈0.05）.CONCLUSION： Small amount of buprenorphine has a good analgesic and sedative effects on pediatric laparoscopic hernia repair under general anesthesia by reducing inflammation and improving immune function.

关 键 词：丁丙诺啡 小儿 全麻下腹腔镜疝气修补术 镇痛作用 

分 类 号：R614[医药卫生—麻醉学]