CAJ | 학술논문

目的观察不同方式超前镇痛对儿童腹腔镜术后多模式镇痛安全性及效果的影响.方法选择在全身麻醉下接受择期腹腔镜手术的患儿90例,年龄5～ 14岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级.采用完全随机双盲法均分为对乙酰氨基酚栓塞肛组(A组)、布托啡诺喷鼻组(B组)和空白对照组(C组).A组患儿全身麻醉后予对乙酰氨基酚栓40 mg/kg塞肛;B组患儿予布托啡诺20μg/kg喷鼻;C组于手术开始前10 min缓慢静脉注射生理盐水2 ml.监测三组患儿术后的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、拔管时间和在PACU停留时间.记录患儿的VAS评分、Ramsay镇静评分及不良反应.结果 A组和B组苏醒期躁动评分显著低于C组(P＜0.01).B组镇静评分显著高于A组和C组(P＜0.01),A组也高于C组(P＜0.05).术后1、4hA组、B组VAS评分显著低于C组(P＜0.01),术后8 h VAS评分低于C组(P＜0.05);术后1、4、8hB组VAS评分低于A组(P＜0.05).C组术后首次按压镇痛泵的时间早于A组和B组(P＜0.01),且按压总次数明显多于A组和B组(P＜ 0.01).结论对乙酰氨基酚栓塞肛和布托啡诺喷鼻均可为儿童腹腔镜手术提供同样安全、有效的超前镇痛效果,但前者不良反应更少,较适合在基层中推广使用.
목적 관찰불동방식초전진통대인동복강경술후다모식진통안전성급효과적영향.방법 선택재전신마취하접수택기복강경수술적환인90례,년령5～ 14세,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급.채용완전수궤쌍맹법균분위대을선안기분전새항조(A조)、포탁배낙분비조(B조)화공백대조조(C조).A조환인전신마취후여대을선안기분전40 mg/kg새항;B조환인여포탁배낙20μg/kg분비;C조우수술개시전10 min완만정맥주사생리염수2 ml.감측삼조환인술후적심솔(HR)、평균동맥압(MAP)、혈양포화도(SpO2)、발관시간화재PACU정류시간.기록환인적VAS평분、Ramsay진정평분급불량반응.결과 A조화B조소성기조동평분현저저우C조(P＜0.01).B조진정평분현저고우A조화C조(P＜0.01),A조야고우C조(P＜0.05).술후1、4hA조、B조VAS평분현저저우C조(P＜0.01),술후8 h VAS평분저우C조(P＜0.05);술후1、4、8hB조VAS평분저우A조(P＜0.05).C조술후수차안압진통빙적시간조우A조화B조(P＜0.01),차안압총차수명현다우A조화B조(P＜ 0.01).결론 대을선안기분전새항화포탁배낙분비균가위인동복강경수술제공동양안전、유효적초전진통효과,단전자불량반응경소,교괄합재기층중추엄사용.
Objective To observe the abirritation effect and safety of multimodal analgesia by different ways of preemptive analgesia after laparoscopic surgery in children.Methods 90 patients (5-14 years old,ASA Ⅰ ～ Ⅱ) scheduled for laparoscopic surgery were selected.With a completely randomized and double blind method,they were divided into three groups with 30 patients in each group.Group A received acetaminophen suppository 40 mg/kg by rectal administration after general anesthesia.Group B received transnasal butorphanol 20 μ g/kg after general anesthesia.Group C received an injection of 2 ml saline before the operation.We observed the HR and BP,RR and SPO2,the time of tracheal extubation and residence time of PACU in three groups.Then we recorded VAS score,Ramsay sedation score and adverse reactions of patients.Results The emergence agitation score in group A and B were significantly lower than those in group C (P ＜ 0.01).The Ramsay score in group B was significantly higher than those in group A and C (P ＜ 0.01),and the score in group A was higher than that in group C (P ＜ 0.05).The VAS score of group A and B were significantly lower than that in group C (P ＜ 0.01) 1 and 4 hours after operation,and it was lower than that in group C 8 hours after operation (P ＜ 0.05).The VAS score of group B was lower than that in group A 1,4 and 8 hours after operation (P ＜ 0.05).The first time to press analgesia pump (PCIA) in group C was significantly earlier than those in group A and B (P ＜ 0.01),and the times of press were more significantly than those in group A and B (P ＜ 0.01).Conclusion Both acetaminophen suppository by rectal administration and transnasal butorphanol administration have the same safe and effective preemptive analgesia effect.But the former has less adverse reactions,which is more suitable for application in the primary hospitals.