右美托咪啶复合芬太尼用于小儿术后镇痛的效果观察.docVIP

右美托咪啶芬太尼镇痛效果 沈杨 张马忠 【摘要】 目的 采用随机、单盲、对照的方法观察右美托咪啶复合芬太尼用于小儿术后镇痛的有效性和安全性。方法 择期行全麻外科手术患儿40例随机分为D组（右美托咪啶5 μg·kg-1 + 芬太尼μg·kg-1配成100ml溶液）和F组（芬太尼μg·kg-1配成100ml溶液），术后静脉自控镇痛药液总量100ml，背景剂量2 ml·h-1，追加量1.5 ml，锁定时间15 min，每小时最大限量6 ml，持续观察24，记录患儿拔管后0 min、30 min、1 h、4 h、12 h和24 h的心率、血压、脉氧饱和度，FLA疼痛评分、Ramsay镇静评分和芬太尼累积消耗量，术后恶心、呕吐、寒战、谵妄、瘙痒等不良反应的发生率。结果 术后8内芬太尼用量显著（P0.05）FLACC疼痛评分Ramsay镇静评分F组（P0.05）但24时两组患者未见过度镇静、心动过缓、低血压、呼吸抑制等不良反应。结论 右旋美托咪啶复合芬太尼用于小儿术后静脉自控镇痛安全有效，明显优于单用芬太尼。 【关键词】右美托咪啶；芬太尼；术后镇痛；儿童 medetomidine enhance the effect of fentanyl for pediatric postoperative analgesia SHEN Yang, JIN Li-hong, ZHANG Ma-zhong. Department of Anesthesiology Pediatric Clinical Pharmacology Laboratory, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China Corresponding author: ZHANG Ma-zhong, Email: zmzscmc@shsmu.edu.cn 【Abstract】 Objective The aim of this study was to determine the efficacy and safety of combining dexmedetomidine and fentanyl for pediatric intravenous patient-controlled analgesia by randomized, single-blind, controlled method. Methods 40 pediatrics undergoing surgery were allocated to receive 100ml solution of either fentanyl 15 μg·kg-1 plus dexmedetomidine 7.5 μg·kg-1 or fentanyl 15 μg·kg-1 alone for postoperative intravenous patient-controlled analgesia, which was programmed to deliver 1.5 ml per demand with 15 min lockout interval and 2 ml·h-1 background infusion. Cumulative fentanyl requirements, pain intensities, cardiovascular and respiratory variables, and adverse events were recorded for 24 h after operation. Results Compared with Group F, patients in Group D required less fentanyl during the 0-8 h postoperative period （P＜0.05), and reported lower levels of FLACC pain scores and sedation at 30min、4 h observational time point（P＜0.05). whereas the fentanyl consumption and the level of sedation were similar between the groups at 24 h observational time point. There was no oversedation, bradycardia, hypotension, or