芬太尼复合咪唑安定用于小儿术后静脉自控镇痛的可行性_医学论文.docVIP

芬太尼复合咪唑安定用于小儿术后静脉自控镇痛的可行性_医学论文 芬太尼复合咪唑安定用于小儿术后静脉自控镇痛的可行性_医学论文 【摘要】 目的 探讨芬太尼复合咪唑安定用于小儿术后静脉自控镇痛的可行性。方法 选择ASAⅠ～Ⅱ级行下腹部手术患儿80例，随机分为4组，4组芬太尼均为5 μg/(kg·d)，A组不用咪唑安定，B、C、D 3组分别为0.25、0.375、0.5 mg/(kg·d)，均加入生理盐水至100 ml。术毕接PCA泵，持续背景输注速度为2 ml/h，患者自控镇痛（PCA）量0.5 ml，锁定时间15 min。于2 h、4 h、8 h、12 h、24 h、48 h记录HR、MAP、RR、SpO2、镇痛评分、镇静评分及呼吸抑制、恶心呕吐等不良反应。结果 镇痛评分B、C、D组均高于A组（P＜0.05或P＜0.01）。镇静评分术后2 h各组差异不明显，但在4 h、8 h、12 h、24 h、48 h各时点，B、C、D 3组均高于A组(0.05或0.01)，C、D组也高于B组(0.05)。A组HR、MAP高于B、C、D组（P均＜0．01），4组RR、SpO2差异不明显。A组出现2例恶心，D组出现1例呼吸抑制。结论 芬太尼复合咪唑安定用于小儿静脉自控镇痛，效果确切，镇静适当，副作用少，适于临床推广。 【关键词】 芬太尼 咪唑安定 小儿 静脉 患者自控镇痛 Abstract: Objective To investigate the efficacy and safety of fentanyl combined with midazolam for child patient-controlled intravenous analgesia (PCIA). Methods Eighty ASAⅠ－Ⅱ children aged 3－12 years undergoing lower abdominal surgery were randomly divided into four groups of 20 each. Group A were only given fentanyl 5 μg/(kg·d) and served as the control. Groups B, C and D as test groups, were given additonal midazolam 0.25, 0.375 and 0.5 mg/(kg·d) respectively. The volume of drugs used for all groups was added to 100 ml with saline. The PCIA included (1) background infusion 2 ml/h and (2) a bolus of 0.5 ml with a 15 min lock-out. The vital signs, pain score, sedation score and side effects were recorded at the points of 2 h, 4 h, 8 h, 12 h, 24 h and 48 h. Results Visual analgesia pain score in group A was significantly higher than in group B （P＜0.05） and groups C and D (P＜0.01). The sedation score of group A was significantly lower than that of groups B, C and D, except at the point of 2 h. The HR and MAP in group A were significantly higher than that in groups B, C and D (P＜0.01) , and there were no significant differences in HR or SpO2 between the four group. Respiratory depression occurred in one patient in group D, and nausea occurred in two patient in group A. Conclusions Fentanyl 5 ug/(kg·d) combined with midazolam 0.25～0.375 mg/(kg·d) for child PCIA has the advantages of good pai