舒芬太尼复合曲马多对学龄前胆总管囊肿患儿术后镇痛及应激反应的影响  

Effect of sufentanil combined with tramadol on postoperative analgesia and stress response in preschool children with choledochal cyst

作　　者：王至立 张晶洁[1] 汪泉[1] 金先庆[1] 徐丽霞[1] 胡颖[1] 卿诗麟 Wang Zhili;Zhang Jingjie;Wang Quan;Jin Xianqing;Xu Lixia;Hu Ying;Qing Shilin(Department of Surgical Anesthesiology of Children’s Hospital of Chongqing Medical University Neonatal Gastrointestinal Surgery of Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,China international Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院手麻科、胃肠新生儿外科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《重庆医科大学学报》2020年第9期1314-1318,共5页Journal of Chongqing Medical University

基　　金：重庆医科大学附属儿童医院临床研究资助项目(编号:lcyj2014-21)。

摘　　要：目的:探讨舒芬太尼复合曲马多静脉自控镇痛(patient-controlled intravaneous analgesia,PCIA)对学龄前胆总管囊肿患儿术后镇痛及应激反应的影响。方法:择期行胆总管囊肿根治术患儿40例,随机分为2组(n=20),镇痛组(P组)和对照组(C组),P组配方为舒芬太尼2μg/kg+曲马多5 mg/kg+地塞米松5 mg+昂丹司琼4 mg+生理盐水稀释至100 mL,C组不予术后镇痛;收集术前1 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)患儿Wong-Baker疼痛评分及不良反应资料,并随访分别在T1-T4各时间点采集患儿外周静脉血,ELISA法检测其血浆肾上腺素(epinephrine,E)、去甲肾上腺素(norepinephrine,NE)、5-羟色胺(5-hydroxytryptamine,5-HT)水平。结果:2组患儿一般情况无统计学差异。重复测量方差分析示Wong-Baker评分在不同组别,不同时间点及分组与时间交互作用均有统计学差异(P<0.05),患儿血浆NE和5-HT水平在不同组别和不同时间点有统计学差异(P<0.05),血浆E、NE、5-HT水平均呈现出先升后降的趋势,在同一时间点行两两比较,T2-T4时P组患儿WongBaker评分和血浆NE、5-HT水平[(3.90±1.65)、(3.10±1.37)、(1.50±1.28)分;(514.13±75.32)、(441.32±69.53)、(364.83±49.33) pg/mL;(262.35±30.31)、(209.38±39.02)、(199.48±30.94) pg/mL]均显著低于C组[(5.30±1.63)、(4.50±1.10)、(2.40±1.23)分;(574.71±100.95)、(483.56±53.47)、(404.61±59.36) pg/mL;(290.81±47.31)、(248.40±48.52)、(232.16±33.75) pg/m L;P<0.05]。2组镇痛相关不良反应、术后短期并发症发生率及术后住院时长无统计学差异(P>0.05);而P组患儿术后非计划拔管率显著低于C组(P<0.05)。患儿血浆NE、5-HT水平与Wong-Baker评分呈正相关,其相关系数分别为r1=0.38、r2=0.56(P<0.05)。结论:舒芬太尼复合曲马多PCIA用于学龄前胆总管囊肿患儿术后镇痛是安全的,可有效缓解患儿术后疼痛,促进其术后恢复,并减轻术后应激反应,无明显不良反应发生。Objective:To investigate the effect of sufentanil combined with tramadol(for patient-controlled intravenous analgesia,PCIA on postoperative analgesia and stress response in preschool children with choledochal cyst. Methods:A total of 40 children undergoing an elective total choledochal cyst excision were enrolled and randomized into PCIA group(group P) and control group(group C)(n=20). The group P was given a formulation of 2 μg/kg sufentanil, 5 mg/kg tramadol,5 mg dexamethasone,and 4 mg ondansetron,diluted to 100 mL by normal saline;the group C was not given any postoperative analgesics. The Wong-Baker scores and adverse reactions of the children were collected at 1 hour before surgery(T1) and 12 hours(T2),24 hours(T3),and48 hours after surgery(T4);meanwhile,peripheral venous blood samples were collected from the children at the above four time points for testing of plasma levels of epinephrine(E),norepinephrine(NE),and 5-hydroxytryptamine(5-HT) by ELISA. Results:There was no significant difference between the two groups in the general condition of the children. A repeated-measure analysis of variance showed that there were significant differences in the Wong-Baker score between different groups and at different time points,with a significant group × time interaction effect observed(P<0.05);there were significant differences in the plasma levels of NE and 5-HT between different groups and at different time points(P<0.05),with an increasing trend followed by a decrease observed in the plasma levels of E,NE,and 5-HT. Compared with the group C,the group P had significantly lower Wong-Baker scores(5.30±1.63 vs. 3.90±1.65,4.50±1.10 vs. 3.10±1.37,2.40±1.23 vs. 1.50±1.28;all P<0.05) and plasma levels of NE(574.71±100.95 vs. 514.13±75.32 pg/mL,483.56±53.47 vs. 441.32±69.53 pg/mL,404.61±59.36 vs. 364.83±49.33 pg/mL;all P<0.05) and 5-HT(290.81±47.31 vs. 262.35±30.31 pg/m L,248.40±48.52 vs. 209.38±39.02 pg/mL,232.16±33.75 vs. 199.48±30.94 pg/mL;all P<0.05) at T2,T3,and T4,respectively. There were no sig

关 键 词：舒芬太尼 曲马多 术后镇痛 学龄前 

分 类 号：R726.1[医药卫生—儿科]