【摘要】 目的:观察帕瑞昔布静注复合芬太尼用于小儿骨科术后镇痛的效果和安全性。方法:选择小儿四肢骨科手术患者84例,分为A、B、C、D 4组。全麻诱导后除A组外B、C、D 3组分别按0.5、1.0、1.5 mg/kg静注帕瑞昔布,各组术毕即行芬太尼患者自控静脉镇痛(PCIA)。于术后记录患儿生命体征及相关数据。结果:(1)疼痛评分:A组在术后0.5、1、2、4、8 h高于C组,术后0.5、1、2、4 h高于D组(P<0.05);B组在术后1、2 h高于C组,术后1、2、4 h高于D组(P<0.05)。(2)镇静评分:C组和D组在0.5、1 h时点高于B组(P<0.05)。(3)芬太尼总用量、按压次数:A、B组分别多于C、D组(P<0.01)。(4)A组不良反应发生率高于C、D组,B组恶心呕吐发生率高于C组(P<0.05)。结论:帕瑞昔布静注复合芬太尼用于小儿骨科术后镇痛可减少芬太尼用量及不良反应,是一种安全有效的镇痛方法。更多还原

【Abstract】 AIM: To investigate the analgesic effect and safty of patient controlled intravenous analgesia(PCIA) by using fentanyl in association with Parecoxib after pediatric orthopaedics operation.METHODS: 84 ASA Ⅰ children undergoing four limbs orthopaedic operation were randomly divided into 4 groups: A,B,C,D.General anesthesia was induced by fentanyl 3 μg/kg,cisatracurium 0.2 mg/kg and propofol 3 mg/kg,children in each group except group A were administered with different single dosage of Parecoxib intravenously after intubation(group B 0.5 mg/kg,group C 1.0 mg/kg,group D 1.5 mg/kg respectively).Continuous fentanyl was infused postoperatively for PCIA within 48 hours.(continuous infusion 0.1 μg·kg-1·h-1,bolus injection 0.05 μg/kg,lockout interval 7 mins).Any children with pain score >3 were administered with a bolus injection("press") by a nurse.The vital signs(HR,RR,BP),SpO2,score of pain and sedation,degree of satisfaction,total dosage of fentanyl,frequency of press(D1),frequency of effective press(D2),adverse reactions were recorded postoperatively at 0.5 h,1 h,2 h,4 h,8 h,24 h and 48 h respectively.RESULTS:(1) The pain score of group A was higher at 0.5 h,1 h,2 h,4 h,8 h compared with group C,as well as higher at 0.5 h,1 h,2 h,4 h compared with group D.The pain score of group B was higher at 0.5 h,1 h,2 h compared with group C,as well as higher at 1 h,2 h,4 h compared with group D.(P<0.05)(2)The sedation score of group A was lower at 1 h compared with group C and D,and the sedation score of group B was lower at 0.5h and 1h compared with group C and D(P<0.05).(3) The total dosage of fentanyl and the total times of press of group A and B was higher compared with group C and D(P<0.01).(4)The incidence of postoperative adverse reactions in group A was higher compared with C and D,and the incidence of nausea and vomiting in group C was higher compared with group B(P<0.05).CONCLUSION: The intravenous single-dose of Parecoxib followed by fentanyl PCIA after padiatric orthopaedics operation is safe and can provide better analgesia.It can also reduce total dosage of fentanyl and the incidence of postoperative adverse reactions.更多还原