【摘要】 目的初步探讨90%PICU气管插管患儿(ED90)有效止痛的芬太尼推注剂量。方法应用行为疼痛量表(Behavioural Pain Scale,BPS)从移动到侧卧位期间进行疼痛评估。纳入BPS评分达到3或4分、入住PICU 48 h内Ramsay评分为3~5分的气管插管和机械通气患儿。在72 h连续侧卧位研究期间,采用BPS量表评价推注芬太尼的镇痛效果。每次翻身侧卧位直到BPS评分为3~4分,芬太尼剂量从0开始按比例升高。收集患儿的Ramsay评分、心率和平均动脉压。结果共纳入25例患儿,进行超过6个月的研究。ED90芬太尼的推注剂量是0.15μg/kg,之后40%的患儿BPS量表评分增加。结论治疗5 d内,90%的患儿镇静有效剂量为0.15μg/kg,无不良反应。经常定期给予PICU患儿急性疼痛评估、预防性推注0.15μg/kg芬太尼可以镇痛,并且可指导医生如何应用最低有效剂量的镇痛药和麻醉药,达到充分镇静止痛的目的,但是应根据不同患儿的病情调整相应剂量。更多还原

【Abstract】 Objective To determine the effective analgesic dose of fentanil on 90% of intubated patients( ED90) in PICU. Methods Intubated and ventilated patients were eligible for the study once they had reached a BPS of 3 or 4 and Ramsay score of 3 ~ 5 within 48 h of admission to PICU. The analgesic efficacy of fentanil was measured by BPS scale during successive lateral decubitus positioning over a 72 h study period. The dose increased with each subsequent turn to lateral decubitus until a BPS score of 3 ~ 4 were obtained( dose escalation,starting at zero). BPS,Ramsay score,heart rate and mean arterial pressure were collected. Results A total of 25 patients were enrolled over 6 months. The ED90 bolus for fentanil was 0. 15 μg / kg,but the BPS of 40% of the patients subsequently demonstrated increased with this dose. Conclusion The effective dose in 90% patients is 0. 15 μg / kg during the first 5 d of sedation without adverse effects. A preemptive fentanil bolus can be used to treat anticipated pain in PICU. Regular and frequent assessments of acute pain and sedation are essential for adjusting the dose. The strategy may help clinicians to keep background infusions of sedatives and narcotics as lowas possible and may improve clinical outcome.更多还原