CAJ | 학술논문

目的：比较氢吗啡酮与舒芬太尼用于脑瘫患儿术后静脉自控镇痛(PCIA)的效果。方法择期拟行颈动脉周围交感神经切除术的脑瘫患儿50例,ASA 分级 I 或Ⅱ级,年龄2~12岁,性别不限。采用随机数字表法,将其分为2组(n =25)：氢吗啡酮组(H 组)和舒芬太尼组(S 组)。镇痛泵配方：H 组氢吗啡酮0．1mg/ kg,输注速率2μg/(kg·h),S 组舒芬太尼3μg/(kg·h),输注速率0．06μg/(kg·h),均加入格拉司琼0．1mg/ kg 及生理盐水稀释至100mL。背景输注剂量为2mL/ h,单次冲击剂量0．5mL,锁时15min。记录术毕(T 0)、术后2h(T 1)、12h(T 2)、24h(T 3)的 MAP、HR、SpO 2、疼痛评分、镇静评分以及术后24hPCIA 累积用量、按压次数(P 1)、实际有效次数(P 2)、皮肤瘙痒、恶心呕吐、嗜睡、尿潴留、呼吸抑制的发生情况及补充镇痛的例数。于 T 0和 T 3时采集外周静脉血样,测定血清 IL-6和 HSP70水平。结果术后24hH 组PCIA 累积用量、按压次数(P 1)和实际有效次数(P 2)均低于 S 组,差异有统计学意义(P <0．05),与 T 0和 H 组比较,S 组在 T 3时血清 IL-6和 HSP70水平降低,差异有统计学意义(P <0．05)。2组患儿各时点 MAP、HR、SPO 2以及皮肤瘙痒、恶心、呕吐、嗜睡、尿潴留、呼吸抑制、需补充镇痛的例数比较差异无统计学意义(P >0．05)。结论氢吗啡酮与舒芬太尼都能为脑瘫患儿术后 PCIA 提供良好的镇痛,氢吗啡酮更有利于免疫功能的调节。
목적：비교경마배동여서분태니용우뇌탄환인술후정맥자공진통(PCIA)적효과。방법택기의행경동맥주위교감신경절제술적뇌탄환인50례,ASA 분급 I 혹Ⅱ급,년령2~12세,성별불한。채용수궤수자표법,장기분위2조(n =25)：경마배동조(H 조)화서분태니조(S 조)。진통빙배방：H 조경마배동0．1mg/ kg,수주속솔2μg/(kg·h),S 조서분태니3μg/(kg·h),수주속솔0．06μg/(kg·h),균가입격랍사경0．1mg/ kg 급생리염수희석지100mL。배경수주제량위2mL/ h,단차충격제량0．5mL,쇄시15min。기록술필(T 0)、술후2h(T 1)、12h(T 2)、24h(T 3)적 MAP、HR、SpO 2、동통평분、진정평분이급술후24hPCIA 루적용량、안압차수(P 1)、실제유효차수(P 2)、피부소양、악심구토、기수、뇨저류、호흡억제적발생정황급보충진통적례수。우 T 0화 T 3시채집외주정맥혈양,측정혈청 IL-6화 HSP70수평。결과술후24hH 조PCIA 루적용량、안압차수(P 1)화실제유효차수(P 2)균저우 S 조,차이유통계학의의(P <0．05),여 T 0화 H 조비교,S 조재 T 3시혈청 IL-6화 HSP70수평강저,차이유통계학의의(P <0．05)。2조환인각시점 MAP、HR、SPO 2이급피부소양、악심、구토、기수、뇨저류、호흡억제、수보충진통적례수비교차이무통계학의의(P >0．05)。결론경마배동여서분태니도능위뇌탄환인술후 PCIA 제공량호적진통,경마배동경유리우면역공능적조절。
Objective To compare the efficacy of hydromorphone versus sufentanil for patient controlled intravenous anal-gesia in children with cerebral palsy surgery. Methods Fifty ASA physical statusⅠor Ⅱchildren with cerebral palsy of both se-xes,aged 2 ~ 12 yr,scheduled for elective carotid peripheral sympathectomy,were randomly allocated into 2 groups(n = 25 each):hydromorphone group(group H) and sufentanil group( group S). The patients received sufentanil 0. 06μg/ ( kg. h) ( group S) or hydromorphone 2μg/ (kg. h)(group H)with granisetron 0. 1mg/ kg and normal saline to 100mL after operation. The PCA pump was set up with a background infusion at 2mL/ h,a bolus dose of 0. 5mL and lockout interval 15min. The MAP,HR,SPO 2 ,NRS scores、Ramsay scores were recorded at the end of operation(T 0 ),and 2h(T 1 )、12h(T 2 )、24h(T 3 )after the operation. The PCIA cumulative volume,press the number( P 1 ) and effective number( P 2 ) after postoperative 24 hours and the skin itching,nausea and vomiting, drowsiness,retention of urine,respiratory depression and the cases of supplementary analgesia were also recorded. Venous blood sam-ples were taken at T 0 and T 3 for determination of serum levels of IL-6 and HSP70. Results The PCIA cumulative volume,P 1 and P 2 after postoperative 24 hours in group H were lower than those of group S(P < 0. 05). Compared with T 0 and group H,The serum IL-6 and HSP70 levels at T 3 in group S were all decreased(P < 0. 05). There was no signify difference in the MAP、HR、SPO 2 at each time and skin itching,nausea and vomiting,drowsiness,retention of urine,respiratory depression and the cases of supplementary analgesia between the two groups(P > 0. 05). Conclusion Both hydromorphone and sufentanil can provide satisfactory analgesia for children with cerebral palsy surgery,hydromorphone is more conducive to the regulation of immune function.