布洛芬注射液预防性镇痛对于儿童扁桃体切除术后苏醒期疼痛的作用研究  

Study on the effect of prophylactic analgesia with ibuprofen injection on awakening period pain in children after tonsillectomy

作　　者：王小雪[1] 高铮铮 马阳巍 张富洲[1] 蔡黎明 张建敏[1] Wang Xiaoxue;Gao Zhengzheng;Ma Yangwei;Zhang Fuzhou;Cai Liming;Zhang Jianmin(Department of Anesthesiology,Beijing Childrens Hospital,Capital Medical University,National Center for Childrens Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院麻醉科,北京100045

出　　处：《临床小儿外科杂志》2024年第9期866-871,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的观察儿童扁桃体(伴或不伴腺样体)切除术中预防性应用布洛芬注射液对于缓解患儿手术后苏醒期疼痛的效果。方法本研究为前瞻性、单中心、双盲、随机对照研究。纳入2021年4月至2021年9月于首都医科大学附属北京儿童医院行全身麻醉下扁桃体(伴或不伴腺样体)切除术的106例患儿作为研究对象, 年龄3~9岁, 男57例、女49例。采用随机数字表法分为观察组(使用布洛芬注射液)52例和对照组(不使用布洛芬注射液)54例。均采用统一的麻醉诱导和全凭静脉维持方案。观察组于手术开始时静脉输注布洛芬注射液, 剂量为10 mg/kg(极量为400 mg), 用0.9%氯化钠注射液稀释, 最终使用浓度不超过4 mg/mL, 输注时间15 min。记录两组患儿苏醒后2 h内、以15 min为间隔的8个时间点(分别记为T1、T2、T3、T4、T5、T6、T7、T8)疼痛评分。疼痛评分采用FLACC评分(Face, Legs, Activity, Cry, Consolability score, FLACC, 分别代表面部表情、腿部活动、体位、哭闹、可安慰度五个方面)。当FLACC评分≥4分, 则静脉单次给予芬太尼0.5 μg/kg进行补救镇痛, 10 min后可根据需要重复使用(最大累积剂量不超过2 μg/kg), 记录补救镇痛的人数及次数。同时从电子病例系统收集患儿年龄、性别、体重指数、诊断等信息, 从麻醉记录中收集麻醉持续时间和拔管时间。结果 T1和T2时间点的FLACC评分在观察组分别为(2.0±2.4)分和(0.6±1.0)分, 对照组分别为(3.5±2.8)分和(1.4±1.4)分, 两组差异有统计学意义(P<0.05)。两组其他时间点的FLACC评分差异无统计学意义(P>0.05)。观察组T2~T8时间点的FLACC评分差异无统计学意义(P>0.05);对照组T2和T3时间点的FLACC评分差异无统计学意义(P>0.05), T4~T8时间点的FLACC评分均低于T2和T3时间点的FLACC分数, 差异有统计学意义(P<0.05)。观察组接受芬太尼补救镇痛的人数较对照组少[(9/52, 17.3%)比(21/54, 38.9%)], 差异有统Objective To observe the effect of prophylactic use of ibuprofen injection during tonsillectomy(with or without adenoidectomy)on alleviating postoperative awakening period pain in children.Methods This study was a prospective,single-center,double-blind,randomized controlled trial.A total of 106 children,aged 3 to 9 years(57 males and 49 females),who underwent tonsillectomy(with or without adenoidectomy)under general anesthesia at Beijing Children’s Hospital,Capital Medical University,from April 2021 to September 2021,were included.The children were randomly divided into an observation group(52 cases)receiving ibuprofen injection and a control group(54 cases)not receiving ibuprofen injection,using a random number table method.A standardized anesthesia induction and total intravenous maintenance protocol was used for all patients.The observation group received an intravenous infusion of ibuprofen injection at the start of surgery,with a dose of 10 mg/kg(maximum dose of 400 mg),diluted with 0.9%sodium chloride injection,with a final concentration not exceeding 4 mg/mL,and infused over 15 minutes.Pain scores were recorded at 8 time points within 2 hours after awakening,at 15-minute intervals(labeled T1,T2,T3,T4,T5,T6,T7,T8).Pain was assessed using the FLACC score(face,legs,activity,cry,consolability score),covering five aspects:facial expression,leg movement,posture,crying,and consolability.If the FLACC score was≥4,fentanyl 0.5μg/kg was administered intravenously for rescue analgesia,with a repeat dose after 10 minutes if necessary(maximum cumulative dose not to exceeding 2μg/kg).The number of patients requiring rescue analgesia and the number of times rescue analgesia was administered were recorded.Additionally,information such as age,gender,body mass index,and diagnosis were collected from the electronic medical records,and anesthesia duration and extubation time were recorded from the anesthesia records.Results The FLACC scores at T1 and T2 time points in the observation group were 2.0±2.4 and 0.6±1.0,resp

关 键 词：扁桃体切除术 麻醉 全身 麻醉和镇痛 布洛芬 儿童 

分 类 号：R47[医药卫生—护理学]