布洛芬注射液对于小儿拇指多指畸形手术后镇痛的效果及安全性研究  

Safety and efficacy of intravenous ibuprofen for treatment of pain in children after polydactylectomy

作　　者：李灵晴 肖婷[1] 陈政[1] Li Lingqing;Xiao Ting;Chen Zheng(Department of Anesthesiology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院麻醉手术科,长沙410007

出　　处：《临床小儿外科杂志》2022年第3期272-277,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省科技厅临床医疗技术创新引导计划(2018sk50407)。

摘　　要：目的 观察舒芬太尼联合布洛芬注射液用于小儿拇指多指畸形手术后镇痛的效果及不良反应,探讨布洛芬注射液对于小儿围手术期镇痛的有效性和安全性。方法 选取湖南省儿童医院2020年9月至2021年9月收治的120例先天性拇指多指畸形患儿作为研究对象,均于全麻下行多指切除截骨矫形克氏针内固定术。诱导给药采取舒芬太尼0.3 ug/kg、丙泊酚2~4 mg/kg静脉推注。依据围手术期是否使用布洛芬注射液分为布洛芬组(n=60)和对照组(n=60),两组术后均使用静脉自控镇痛泵(舒芬太尼0.04μg·kg^(-1)·h^(-1)持续泵注);布洛芬组手术后联合使用布洛芬注射液,单次给药剂量为10 mg/kg,每8 h给药1次,给药持续至术后48 h;对照组在相同时间给予等量生理盐水。观察两组术后镇痛效果以及不良反应情况。结果 布洛芬组患儿术后2 h、8 h、24 h及48 h的FLACC疼痛评估量表(face legs activity cry and consolability behavioral pain assessment tool)评分均低于对照组(P<0.01);PCA按压次数少于对照组(Z=-6.161,P<0.01);术后舒芬太尼总计用量均值为18.01μg,低于对照组的24.05μg(t=-7.289,P<0.01);镇痛补救率为6.7%(4/60),低于对照组的20.0%(12/60),差异有统计学意义(χ^(2)=4.615,P=0.032);术后镇痛满意度评分及睡眠满意度评分均高于对照组,差异有统计学意义(P<0.01)。两组患儿术后头晕、呕吐、嗜睡、皮肤瘙痒等不良反应的发生率比较,差异均无统计学意义(P>0.05);对照组术后发热患儿例数多于布洛芬组,差异有统计学意义(P<0.05)。结论 布洛芬注射液可安全应用于小儿手术后镇痛;相比单纯使用舒芬太尼,术后联合布洛芬注射液可获得更好的镇痛效果,且能减少阿片类药物的用量,用于小儿手术后镇痛安全有效。Objective To observe the analgesic efficacy and adverse reactions of sufentanil combined with intravenous ibuprofen for children who underwent polydactylectomy and explore the safety and effectiveness of intravenous ibuprofen for perioperative analgesia in children.Methods A total of 120 children diagnosed with congenital thumb anomalies and undergoing polydactylectomy,osteotomy and internal fixation with Kirschner wire from September 2020 to September 2021 were selected as study subjects.Snfentani 0.3μg/kg and propofol 2-4 mg/kg were used for anesthesia induction.The patients were divided into the ibuprofen group(n=60) and the control group(n=60)according to whether intravenous ibuprofen was used after surgery.Both groups were given patient controlled intravenous analgesia(PCIA)after surgery(sufentanil 0.04μg·kg^(-1)·h^(-1)infusion continuously).The Ibuprofen group received a single dose of 10 mg/kg intravenous ibuprofen every 8 h,until 48 h after surgery while the control group received the same dose of normal saline simultaneously.The analgesic efficacy and adverse reactions of the two groups were evaluated.Results The FLACC scores at 2 h,8 h,24 h and 48 h after operation in ibuprofen group were significantly lower than that of the control group(P<0.01);the pressing times of PCA was fewer in the ibuprofen group(Z=-6.161,P<0.01);the mean value of the postoperative consumption of sufentanil in the ibuprofen and control group was 18.01μg and 24.05μg respectively,and the difference was statistically significant(t=-7.289,P<0.01);the percentage of requiring rescue analgesia was 6.7%(4/60)in ibuprofen group and 20.0%(12/60)in the control group,and the difference was statistically significant(χ^(2)=4.615,P=0.032);the scores of postoperative analgesic satisfaction and sleep satisfaction of patients in the ibuprofen group were significantly higher than those in the control group(P<0.01).There was no significant difference in the incidence of adverse reactions such as dizziness,vomiting,drowsiness,and skin pruritu

关 键 词：多指(趾)畸形/外科学 麻醉和镇痛/方法 布洛芬/投药和剂量 布洛芬/副作用 有效性研究 

分 类 号：R726.1[医药卫生—儿科]