CAJ | 학술논문

目的：探讨右美托咪定混合舒芬太尼用于漏斗胸患儿Nuss术后自控静脉镇痛的适宜药量配比。方法择期全麻行Nuss手术的漏斗胸患儿60例，年龄5～12岁，性别不限，ASA分级Ⅰ或Ⅱ级，体重18～50 kg，采用随机数字表法分为3组（ n＝20）：舒芬太尼混合右美托咪定不同药量配比组（ SD1－3组）。术后镇痛：SD1组舒芬太尼1μg∕kg ＋右美托咪定2μg∕kg，SD2组舒芬太尼1μg∕kg ＋右美托咪定3μg∕kg，SD3组舒芬太尼1μg∕kg ＋右美托咪定4μg∕kg，各组均混合使用托烷司琼0．1 mg∕kg＋地塞米松0．1 mg∕kg，用生理盐水稀释至100 ml，背景输注速率2 ml∕h，PCA剂量0．5 ml，锁定时间15 min。手术结束即刻连接PCA泵，术后48 h内采用舒芬太尼0．1μg∕kg进行补救镇痛，维持VAS评分＜4分，记录补救镇痛情况。术后4、8、12、24和48 h时记录Ramsay镇静评分，记录术后48 h内恶心呕吐、心动过缓、过度镇静、呼吸抑制、躁动和寒战的发生情况。结果患儿均未见恶心呕吐、呼吸抑制、心动过缓、过度镇静和寒战发生。 SD2组和SD3均未行补救镇痛。与 SD1组比较，SD2组和SD3组补救镇痛率和躁动发生率降低，术后4、8 h时Ramsay镇静评分升高（ P＜0．05）。与SD2组比较， SD3组术后4 h时Ramsay镇静评分升高（ P＜0．05）。结论右美托咪定3μg∕kg混合舒芬太尼1μg∕kg为漏斗胸患儿Nuss术后自控静脉镇痛的适宜药量配比。
목적：탐토우미탁미정혼합서분태니용우루두흉환인Nuss술후자공정맥진통적괄의약량배비。방법택기전마행Nuss수술적루두흉환인60례，년령5～12세，성별불한，ASA분급Ⅰ혹Ⅱ급，체중18～50 kg，채용수궤수자표법분위3조（ n＝20）：서분태니혼합우미탁미정불동약량배비조（ SD1－3조）。술후진통：SD1조서분태니1μg∕kg ＋우미탁미정2μg∕kg，SD2조서분태니1μg∕kg ＋우미탁미정3μg∕kg，SD3조서분태니1μg∕kg ＋우미탁미정4μg∕kg，각조균혼합사용탁완사경0．1 mg∕kg＋지새미송0．1 mg∕kg，용생리염수희석지100 ml，배경수주속솔2 ml∕h，PCA제량0．5 ml，쇄정시간15 min。수술결속즉각련접PCA빙，술후48 h내채용서분태니0．1μg∕kg진행보구진통，유지VAS평분＜4분，기록보구진통정황。술후4、8、12、24화48 h시기록Ramsay진정평분，기록술후48 h내악심구토、심동과완、과도진정、호흡억제、조동화한전적발생정황。결과환인균미견악심구토、호흡억제、심동과완、과도진정화한전발생。 SD2조화SD3균미행보구진통。여 SD1조비교，SD2조화SD3조보구진통솔화조동발생솔강저，술후4、8 h시Ramsay진정평분승고（ P＜0．05）。여SD2조비교， SD3조술후4 h시Ramsay진정평분승고（ P＜0．05）。결론우미탁미정3μg∕kg혼합서분태니1μg∕kg위루두흉환인Nuss술후자공정맥진통적괄의약량배비。
Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient?controlled intravenous analgesia ( PCIA) after Nuss procedure in pedi?atric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical statusⅠorⅡ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table:different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups ( SD1-3 groups) . Postopera?tive analgesia was as follows: group SD1 received sufentanil 1 μg∕kg + dexmedetomidine 2 μg∕kg; group SD2 received sufentanil 1 μg∕kg + dexmedetomidine 3 μg∕kg; group SD3 received sufentanil 1 μg∕kg +dexmedetomidine 4 μg∕kg. A mixture of tropisetron 0?1 mg∕kg and dexamethasone 0?1 mg∕kg ( in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0?5 ml with a lockout interval of 15 min and background infusion at 2 ml∕h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0?1μg∕kg was used as a rescue analgesic within 48 h post?operatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over?sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over?sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1 , the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after oper?ation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg∕kg mixed with sufentanil 1μg∕kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum.