父母控制与持续输注镇痛用于学龄前儿童术后镇痛效果的比较  

Comparison between parent-controlled and continuous infusion analgesia in preschool children

作　　者：张弦[1] 潘守东[1] 陈刚[1] 刘宏妍[1] 李帆[1] 郭嘉 ZHANG Xian;PAN Shou-dong;CHEN Gang;LIU Hong-yan;LI Fan;GUO Jia(Department of Anesthesiology, Capital Institute of Pediatrics A ffiliated Children's Hospital, Beijing 100020, China;Postanesthesia Care Unit, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China)

机构地区：[1]首都儿科研究所附属儿童医院麻醉科,北京100020 [2]首都儿科研究所附属儿童医院麻醉恢复室,北京100020

出　　处：《中国医刊》2019年第4期389-391,共3页Chinese Journal of Medicine

摘　　要：目的比较父母控制镇痛与持续输注镇痛两种术后镇痛方式在学龄前儿童中的有效性和安全性。方法选择2015年1月至2017年12月首都儿科研究所附属儿童医院收治的拟在全麻下行择期腹腔镜手术的学龄前儿童217例,年龄1～6岁,性别不限,ASA分级Ⅰ—Ⅱ级,随机分为持续输注镇痛组(C组,n=108)和父母控制镇痛组(P组,n=109)。两组手术结束前均经静脉给予舒芬太尼负荷量0.05μg/kg,C组使用一次性输注泵持续输注舒芬太尼0.04μg/(kg·h);P组使用电子注药泵,设置背景剂量0.04μg/(kg·h),单次按压剂量0.02μg/kg,锁定时间15min,由父母控制镇痛。观察并记录术后0.5h(T_1)、1h(T_2)、2h(T_3)、6h(T_4)、12h(T_5)、24h(T_6)的FLACC镇痛评分、Ramsay镇静评分及镇痛相关不良反应。结果 P组在T1时点的FLACC镇痛评分及Ramsay镇静评分优于C组,差异有显著性(P<0.05),其他时点两组镇痛和镇静评分比较差异均无显著性(P>0.05)。P组和C组分别有5例(4.6%)和3例(2.8%)患儿发生术后呕吐,组间比较差异无显著性(P>0.05),两组均无其他镇痛相关并发症发生。结论学龄前儿童术后由父母控制镇痛的临床效果优于持续输注镇痛,且不增加镇痛相关不良反应的发生率。Objective To compare the efficacy and safety between parent-controlled and continuous infusion analgesia in preschool children. Method Two hundred and seventeen preschool children, aged 1-6 year, ASA I-II, undergoing selective laparoscopic surgeries,were randomly divided into 2 groups: group C(continuous infusion analgesia group, n=108) and group P(parent-controlled analgesia group, n=109). A loading dose of intravenous sufentanil 0.05 mg/kg was given to both groups 5 min before the end of the surgery. Then the postoperative analgesia was maintained with continuous infusion of sufentanil 0.04μg/(kg·h) with disposable infusion pump(Accufuser,Korea) in group C, and parent-controlled analgesia with sufentanil with electronic infusion pump(Aipeng ZZB-Ⅰ, Nantong, China), at a basal rate of 0.04μg/(kg·h), bolus dose of 0.02μg/kg, and lockout time of 15 min, in group P, respectively. The FLACC behavioral pain scale, the Ramsay sedation scale, and all of the side effects related to analgesia, were assessed regularly at 0.5, 1, 2, 6, 12 and 24 hours postoperatively. Result The FLACC scores and the Ramsay scores at 0.5 hour, postoperatively, were better in group P than that in group C(P<0.05). There were 5(4.6%) and 3(2.8%) cases of postoperative vomiting in group P and group C, respectively(P>0.05), and no other analgesia related side effects was observed. Conclusion Parent-controlled analgesia is better than continuous infusion analgesia in preschool children, with no additional analgesia related side-effects.

关 键 词：儿童 学龄前 术后镇痛 舒芬太尼 药效学 不良反应 

分 类 号：R614[医药卫生—麻醉学]