上海医学
上海醫學
상해의학
SHANGHAI MEDICAL JOURNAL
2010年
2期
159-162
,共4页
丁丙诺菲%舒芬太尼%术后镇痛%小儿先天性心脏病%皮质醇
丁丙諾菲%舒芬太尼%術後鎮痛%小兒先天性心髒病%皮質醇
정병낙비%서분태니%술후진통%소인선천성심장병%피질순
Buprenorphine%Sulfentanil%Postoperative analgesia%Infantile congenital heart disease%Cortisol
目的 观察丁丙诺菲、舒芬太尼对先天性心脏病婴幼儿术后镇痛的疗效和安全性.方法 收集郑州大学第三附属医院2008年1-7月确诊为中小型室间隔缺损或(和)房间隔缺损并拟在静吸复合全身麻醉体外循环下行右侧开胸室间隔缺损或(和)房间隔缺损修补术的患儿45例,年龄1～3岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机均分成3组.术毕,C组以负荷量为0、维持量为2～3 mL/h经微量泵静脉注射0.9%氯化钠溶液;B组以负荷量为2μg/kg、维持量为0.5μg·kg~(-1)·h~(-1)经微量泵静脉注射丁丙诺菲;S组以负荷量为0.2μg/kg、维持量为0.075μg·kg~(-1)·h~(-1)经微量泵静脉注射舒芬太尼.于术后8(T_1)、14(T_2)、24(T_3)、32 h(T_4)4个时间点进行观察.结果 3组间一般资料、气管导管拔管时间的差异均无统计学意义(P值均>0.05).3组在各时间点的动脉血二氧化碳分压(PaCO_2)的差异均无统计学意义(P值均>0.05),C组在T_1、T_2、T_33个时间点的疼痛行为评估量表(FLACC)疼痛评分显著高于B、S组(P值均<0.05),B组又显著高于S组(P值均<0.05).C组在5个时间点的血清皮质醇(Cor)水平的差异无统计学意义(P值均>0.05).B、S组在T_1、T_2、T_3、T_4时间点的血清Cor水平均显著低于同组T_0时间点(P值均<0.05).在T_0时间点C、B、S组间血清Cor水平的差异均无统计学意义(P值均>0.05).C组在T_1、T_2、T_3、T_4时间点的血清Cor水平显著高于B、S组(P值均<0.05),而B组又显著高于S组(P值均<0.05).在T_2时间点,3组的血清Cor水平均显著高于生理标准范围的上限值598 mg/L~(-1)(P<0.05).C、B、S组发生烦躁的次数分别为(11.20±1.32)、(8.87±1.36)和(6.93±1.33)次,3组间差异有统计学意义(P值均<0.05);3组间发生恶心、呕吐次数的差异均无统计学意义(P值均>0.05).结论 丁丙诺菲、舒芬太尼应用于小儿先天性心脏病术后镇痛均安全、有效,舒芬太尼的镇痛效果更完善,且不良反应更小.
目的 觀察丁丙諾菲、舒芬太尼對先天性心髒病嬰幼兒術後鎮痛的療效和安全性.方法 收集鄭州大學第三附屬醫院2008年1-7月確診為中小型室間隔缺損或(和)房間隔缺損併擬在靜吸複閤全身痳醉體外循環下行右側開胸室間隔缺損或(和)房間隔缺損脩補術的患兒45例,年齡1～3歲,美國痳醉醫師學會(ASA)分級Ⅰ～Ⅱ級,隨機均分成3組.術畢,C組以負荷量為0、維持量為2～3 mL/h經微量泵靜脈註射0.9%氯化鈉溶液;B組以負荷量為2μg/kg、維持量為0.5μg·kg~(-1)·h~(-1)經微量泵靜脈註射丁丙諾菲;S組以負荷量為0.2μg/kg、維持量為0.075μg·kg~(-1)·h~(-1)經微量泵靜脈註射舒芬太尼.于術後8(T_1)、14(T_2)、24(T_3)、32 h(T_4)4箇時間點進行觀察.結果 3組間一般資料、氣管導管拔管時間的差異均無統計學意義(P值均>0.05).3組在各時間點的動脈血二氧化碳分壓(PaCO_2)的差異均無統計學意義(P值均>0.05),C組在T_1、T_2、T_33箇時間點的疼痛行為評估量錶(FLACC)疼痛評分顯著高于B、S組(P值均<0.05),B組又顯著高于S組(P值均<0.05).C組在5箇時間點的血清皮質醇(Cor)水平的差異無統計學意義(P值均>0.05).B、S組在T_1、T_2、T_3、T_4時間點的血清Cor水平均顯著低于同組T_0時間點(P值均<0.05).在T_0時間點C、B、S組間血清Cor水平的差異均無統計學意義(P值均>0.05).C組在T_1、T_2、T_3、T_4時間點的血清Cor水平顯著高于B、S組(P值均<0.05),而B組又顯著高于S組(P值均<0.05).在T_2時間點,3組的血清Cor水平均顯著高于生理標準範圍的上限值598 mg/L~(-1)(P<0.05).C、B、S組髮生煩躁的次數分彆為(11.20±1.32)、(8.87±1.36)和(6.93±1.33)次,3組間差異有統計學意義(P值均<0.05);3組間髮生噁心、嘔吐次數的差異均無統計學意義(P值均>0.05).結論 丁丙諾菲、舒芬太尼應用于小兒先天性心髒病術後鎮痛均安全、有效,舒芬太尼的鎮痛效果更完善,且不良反應更小.
목적 관찰정병낙비、서분태니대선천성심장병영유인술후진통적료효화안전성.방법 수집정주대학제삼부속의원2008년1-7월학진위중소형실간격결손혹(화)방간격결손병의재정흡복합전신마취체외순배하행우측개흉실간격결손혹(화)방간격결손수보술적환인45례,년령1～3세,미국마취의사학회(ASA)분급Ⅰ～Ⅱ급,수궤균분성3조.술필,C조이부하량위0、유지량위2～3 mL/h경미량빙정맥주사0.9%록화납용액;B조이부하량위2μg/kg、유지량위0.5μg·kg~(-1)·h~(-1)경미량빙정맥주사정병낙비;S조이부하량위0.2μg/kg、유지량위0.075μg·kg~(-1)·h~(-1)경미량빙정맥주사서분태니.우술후8(T_1)、14(T_2)、24(T_3)、32 h(T_4)4개시간점진행관찰.결과 3조간일반자료、기관도관발관시간적차이균무통계학의의(P치균>0.05).3조재각시간점적동맥혈이양화탄분압(PaCO_2)적차이균무통계학의의(P치균>0.05),C조재T_1、T_2、T_33개시간점적동통행위평고량표(FLACC)동통평분현저고우B、S조(P치균<0.05),B조우현저고우S조(P치균<0.05).C조재5개시간점적혈청피질순(Cor)수평적차이무통계학의의(P치균>0.05).B、S조재T_1、T_2、T_3、T_4시간점적혈청Cor수평균현저저우동조T_0시간점(P치균<0.05).재T_0시간점C、B、S조간혈청Cor수평적차이균무통계학의의(P치균>0.05).C조재T_1、T_2、T_3、T_4시간점적혈청Cor수평현저고우B、S조(P치균<0.05),이B조우현저고우S조(P치균<0.05).재T_2시간점,3조적혈청Cor수평균현저고우생리표준범위적상한치598 mg/L~(-1)(P<0.05).C、B、S조발생번조적차수분별위(11.20±1.32)、(8.87±1.36)화(6.93±1.33)차,3조간차이유통계학의의(P치균<0.05);3조간발생악심、구토차수적차이균무통계학의의(P치균>0.05).결론 정병낙비、서분태니응용우소인선천성심장병술후진통균안전、유효,서분태니적진통효과경완선,차불량반응경소.
Objective To observe the efficacy and safety of buprenorphine and sulfentanil for postoperative analgesia in infants after cardiac surgery. Methods Forty-five patients aged 1-3 years with ventricular or(and) atrial septal defect (American Society of Anesthesiologists class Ⅰ-Ⅱ), who were treated in our hospital during Jan. 2008 to Jul. 2008, were included in the present study. The patients were divided into 3 groups: control group was given normal saline;group B was given buprenorphine, and group S was given sulfentanil. Group C was given normal saline with an injection speed of 2-3 mL/h by microinfusion pump. Group B was given bolus infusion of buprenorphine 2 μg/kg and continuous infusion of 0.5 μg·kg~(-1)·h~(-1). Group S was given bolus infusion of sufentanil 0.2 μg/kg and continuous infusion 0. 075 μg·kg~(-1)·h~(-1). The data were observed at postoperation (T_0), 8 h(T_1), 14 h(T_2), 24 h(T_3) and 32 h(T_4). Results The general data pressure of arterial carbon dioxide (PaCO_2) and the time of extubation were similar between the three groups. The scores of the Face, Legs, Activity, Cry, Consolability Pain Scale (FLACC) of the three group at T_1,T_2, and T_3 were significantly different (P<0.05). The differences of cortisol (Cor) values of the five time points in the C group was not significantly different (P>0.05). The Cor value at the four time points in group B and S were significantly smaller than at T_0 (P<0.05). The differences of the Cor value at T_0 of the three groups were not significantly different (P>0.05). The difference of Cor values at T_1, T_2, T_3, and T_4 in the three groups were significantly different (P<0.05). The Cor values of the three group at T_2 was significantly higher than the ceiling value of the physiological standard (μ=598 mg/L, P<0.05). The frequencies of fidget were significantly different between the three groups (11.20±1.32 vs. 8.87±1.36 vs. 6.93±1.33, P<0.05). The frequencies of vomiting in the three groups were similar. Conclusion Postoperative analgesia with buprenorphine or sulfentanil for infants with congenital heart disease is safe and effective, and the analgesic effect of the latter is better, with less side effects.
