滴定式镇痛在小儿重型颅脑损伤术后的应用  

Clinical research of titration analgesia applying in severe traumatic brain injury in children

作　　者：余四海 刘亚丽 芦乙滨 YU Sihai;LIU Yali;LU Yibin(Central Hospital of Xinyang City of Henan Province/Affiliated Xinyang Hospital of Zhengzhou University,Xinyang 464000,CHN)

机构地区：[1]河南省信阳市中心医院/郑州大学附属信阳医院,河南信阳464000

出　　处：《河南大学学报（医学版）》2024年第2期126-130,共5页Journal of Henan University:Medical Science

基　　金：中华国际医学交流基金会ICU镇痛镇静专项研究基金(Z-2017-24-2028-37)。

摘　　要：目的:探讨滴定式镇痛在小儿重型颅脑损伤术后应用的临床可行性。方法:选择2018年1月至2021年1月,某医院儿童重症监护病房(PICU)收治的56例重型颅脑损伤手术患儿作为研究对象。按照随机数字表法分组:滴定式镇痛组28例,常规镇痛组28例。滴定式镇痛组瑞芬太尼3μg·kg^(-1)·h^(-1)起始,根据心率、有创动脉压、脑血流、FLACC评分(儿童疼痛评估FLACC量表)等调整剂量,使FLACC评分2~3分之间,保持浅镇痛状态。在术后24h及有创操作(如吸痰、穿刺等)前,增加镇痛强度使FLACC评分0~1分之间,操作结束恢复浅镇痛状态。常规镇痛组瑞芬太尼3μg·kg^(-1)·h^(-1)起始,根据心率、有创动脉压、脑血流、FLACC评分等调整剂量,使FLACC评分持续保持0~1分之间。所有患儿均给予咪达唑仑1~5μg·kg^(-1)·min^(-1)镇静,保持镇静深度RASS评分-2~0之间。所有患儿均入院24h内急诊手术、根据病情给予降颅压、止血、维持血压、机械通气等综合治疗。观察两组患儿的心率、有创动脉压、PCIS评分、GCS评分、及机械通气时间、呼吸机相关性肺炎(VAP)发生率、不良事件发生情况及镇痛镇静药物应用总量。结果:与常规镇痛组比较。①PCIS评分:滴定式镇痛组,PCIS评分恢复更快。②GCS评分:术后72h内评分上升例数更多,意识恢复时间相对缩短。③机械通气时间、呼吸机相关性肺炎(VAP)发生率:滴定式镇痛组,机械通气时间更短,呼吸机相关性肺炎发生率更低。④不良事件发生情况:心动过缓、低血压、低氧血症、意外拔管率无统计学差异。⑤镇痛、镇静药物应用总量更少。且研究中,患儿生命体征监测发现,滴定式镇痛组,术后72h内有创动脉压、心率波动更少,更加稳定。结论:滴定式镇痛策略可使小儿重型颅脑损伤术后心率、有创动脉压更趋向稳定,有助于重型颅脑损伤患儿术后的生命体征、神经功能恢复,缩短机械Objective:To invetigate the value and feasibility of titration analgesia applying in severe traumatic brain injury in children.Methods:A total of 56 children patients with severe craniocerebral injury who were admitted to the pediatric intensive care unit(PICU).From January 2018 to January 2021 were included and randomly divided into titration analgesia group and routine analgesia group.There were 28 patients in per group,Titrated analgesia group:.remifentanil 3 μg·kg^(-1)·min^(-1) was used to start,and the dose was adjusted according to heart rate,invasive arterial.pressure,cerebral blood flow,FLACC score(Child Pain Assessment FLACC Scale).etc.so that the FLACC score was between 2~3 points,and the light analgesia state was maintained,The analgesia intensity was increased 24 h postoperative and before invasive procedures(such as sputum aspiration,puncture,etc.)to make FLACC score between 0 and 1,and the light analgesia state was resumed after the operation.Routine analgesia group:remifentanil was started at3 μg·kg^(-1)·h^(-1),and the dosage was adjusted according to heart rate,invasive arterial pressure,cerebral blood flow,FLACC score,etc..so that FLACC score was maintained between 0 and 1.All patients were sedated with midazolam 1-5μg·kg^(-1)·min^(-1)。and maintained the RASS score between -2 and 0.All patients were received emergency surgery within 24 hours after admission,and were given comprehensive treatment(such as reducing intracranial pressure,hemostasis,maintaining blood pressure and mechanical ventilation etc)and adverse events were recorded in the two groups of heart rate,invasive arterial pressure,PCIS score,GCS score,duration of mechanical ventilation,the incidence of ventilator associated pneumonia(VAP),the incidence of adverse events and the total amount of analgesic and sedative drugs.Results:Among the 56 patients,patients who received titration analgesia therapy had recovering faster PCIS score and GCS score.And the recovery time of consciousness and the Mechanical ventilation time was

关 键 词：滴定式镇痛 小儿 重型颅脑损伤 术后 

分 类 号：R651.15[医药卫生—外科学]