瑞芬太尼与芬太尼对小儿斜视纠正术术后恶心呕吐和疼痛影响对比研究.docVIP

瑞芬太尼与芬太尼对小儿斜视纠正术术后恶心呕吐和疼痛影响对比研究 　　【摘要】 目的 对比短时效阿片类药物-瑞芬太尼与芬太尼对小儿斜视术后呕吐和疼痛的作用的差别。方法 60名ASA I～II级,2～12岁择期在全麻下行斜视纠正术的小儿,随机分为两组,R组(瑞芬太尼)与F组(芬太尼)。术后记录25 h呕吐事件。苏醒后60 min记录疼痛评分。结果 两组术后呕吐发生率没有统计学差异(49% vs 48%)。但是R组术后呕吐频率较F组低(0.95 vs 2.2)。苏醒后头30 min,F组术后疼痛评分较低。结论 平衡全麻下小儿斜视术后,瑞芬太尼组术后呕吐发生频率较少,但芬太尼组对术后早期镇痛效果较好。 　　【关键词】 瑞芬太尼;芬太尼;术后恶心呕吐;疼痛;斜视手术 　　 　　A comparison of remifentanil and fentanyl for postoperative vomiting and pain after strabismus surgery 　　CHEN Ying,LIAO Zhijie,CHEN Qianru,et al.Department of Anesthesiology,Zhongshan Ophthalmology Ceater of Zhongsshan University Guangzhou 510600,China 　　【Abstract】 Objective To compare the effect of remifentanil with fentanyl on postoperative vomiting and pain in children undergoing strabismus surgery. Methods 60 ASA status I or II children from 2~12 years undergoing elective strabismus surgery under general anesthesia. Children were randomized to receive either remifentanil (Group R) or fentanyl (Group F). POV episodes were recorded for 25 hour. pain scores were obtained by using an objective pain scale for 60 min during recovery. Results The number of patients who experienced POV did not differ significantly between groups(49% vs 48%). However, in the group R, POV episodes were significantly less frequent(0.95 vs 2.2). In contrast, fentanyl was associated with lower pain scores during the first 30 min of recovery. ConclusionChild undergoing strabismus surgery under balanced anesthesia with remifentanil, compared with fentanyl, shows less frequent POV. However, early postoperative analgesia is better with fentanyl. 　　【Key words】 Remifentanil;Fentanyl;PONV;Pain;Strabismus surgery 　　 　　小儿行斜视术后常出现呕吐。由于不同麻醉技术、抗呕吐治疗及手术时间和类型、患者个体差异的差别,发生率为15%～75% [1]。术后恶心呕吐增加患者痛苦,增加住院率[2]。 　　围术期阿片类药物的应用显著增加了术后呕吐的发生,且与剂量有关[3]。小儿斜视纠正术,静脉应用吗啡诱导较酮络酸术后呕吐发生率明显增加(71% vs 9%)[4]。瑞芬太尼具有酯键,因而结构独特。酯键易被血和组织中的非特异性酯酶消解,导致其代谢迅速,时-量相关半衰期3～4 min。与长效阿片类药物相比,瑞芬太尼超短半衰期的特点对小儿斜视术后呕吐发生率的影响尚未明确。本研究旨在对比瑞芬太尼与芬太尼对术后呕吐及疼痛的影响,以寻找小儿斜视手术的最佳麻醉药物。 　　 　　1 资料与方法 　　 　　1.1 一般资料