【摘要】 目的比较不同剂量芬太尼复合盐酸右美托咪定对小儿骨科手术术后静脉自控镇痛（PCIA）的效果及安全性。方法选取2018年1月-2020年3月于福建省南平市第一医院行胫骨、肱骨、股骨、尺桡骨骨折手术治疗的患儿120例,采用随机数字表法分为3组,每组40例,3组均连接PCIA泵,Ⅰ组使用芬太尼8.0μg/kg+托烷司琼0.1 mg/kg+盐酸右美托咪定2μg/kg,Ⅱ组使用芬太尼10.0μg/kg+托烷司琼0.1 mg/kg+盐酸右美托咪定2μg/kg,Ⅲ组使用芬太尼12.0μg/kg+托烷司琼0.1 mg/kg+盐酸右美托咪定2μg/kg,PCIA泵背景输注速率2 ml/h,单次给药剂量0.5 ml,锁定时间15 min。比较3组患儿术后4、8、12、24、48 h的镇痛评分、镇静评分、心率（HR）、脉搏血氧饱和度（Sp O₂）、呼吸频率（RR）、镇痛补救率及不良反应。结果术后4、8、12、24、48 h,Ⅱ组、Ⅲ组患儿镇痛评分低于Ⅰ组（P<0.05）,Ⅱ组与Ⅲ组患儿镇痛评分比较差异无统计学意义（P>0.05）;Ⅲ组患儿Ramsay镇静评分高于Ⅰ组、Ⅱ组（P<0.05）,Ⅰ组与Ⅱ组患儿Ramsay镇静评分比较差异无统计学意义（P>0.05）。术后4、8、12、24、48 h,Ⅱ组、Ⅲ组患儿HR低于Ⅰ组（P<0.05）,Ⅱ组与Ⅲ组患儿HR比较差异无统计学意义（P>0.05）;术后4、8、12、24 h,Ⅱ组、Ⅲ组患儿RR低于Ⅰ组（P<0.05）,Ⅱ组与Ⅲ组患儿RR比较差异无统计学意义（P>0.05）;术后不同时点3组患儿Sp O₂比较差异均无统计学意义（P>0.05）。Ⅱ组、Ⅲ组患儿镇痛补救率低于Ⅰ组（P<0.05）,Ⅲ组患儿恶心呕吐发生率高于Ⅰ组和Ⅱ组（P<0.05）。结论芬太尼10.0μg/kg+托烷司琼0.1 mg/kg+盐酸右美托咪定2μg/kg用生理盐水稀释后采用PCIA泵静脉持续输注的术后镇痛效果好,且安全性高,值得临床推广使用。更多还原

【Abstract】 Objective To compare the efficacy and safety of fentanyl combined with dexmedetomidine hydrochloride in the treatment of patient controlled intravenous analgesia（PCIA） after pediatric orthopedic surgery.Methods A total of 120 children with tibia,humerus,femur,ulnar and radius fractures who underwent surgical treatment in the First Hospital of Nanping City,Fujian Province from January 2018 to March 2020 were selected and divided into 3 groups by random number table method,with 40 cases in each group.The three groups were connected with intravenous controlled analgesia （PCIA）pump.GroupⅠwas treated with fentanyl 8.0μg/kg+tropisetron 0.1 mg/kg+dexmedetomidine hydrochloride 2 μg/kg,groupⅡwas treated with fentanyl 10.0μg/kg+tropisetron 0.1 mg/kg+dexmedetomidine hydrochloride 2 μg/kg.GroupⅢwas given fentanyl 12.0μg/kg+tropisetron 0.1 mg/kg+dexmedetomidine hydrochloride 2 μg/kg,PCIA pump background infusion rate 2 ml/h,single dose 0.5 ml,locking time 15 min.The analgesic score,sedation score,heart rate（HR）,pulse oxygen saturation（Sp O₂）,respiratory rate（RR）,analgesic recovery rate and adverse reactions of 3 groups were compared at4,8,12,24,48 h after operation.Results At 4,8,12,24,48 h after surgery,the analgesia score of groupⅡand groupⅢwere lower than that of groupⅠ（P<0.05）,and there was no significant difference between groupⅡand groupⅢ（P>0.05）.Ramsay sedation score in groupⅢwas higher than that in groupⅠand groupⅡ（P<0.05）,and there was no significant difference between groupⅠand groupⅡ（P>0.05）.At 4,8,12,24,48 h after surgery,the HR of groupⅡand groupⅢwere lower than that of groupⅠ（P<0.05）,and there was no significant difference between groupⅡand groupⅢ（P>0.05）.At 4,8,12,24 h after surgery,the RR of groupⅡand groupⅢwere lower than that of groupⅠ（P<0.05）,and there was no significant difference between groupⅡand groupⅢ（P>0.05）.There was no significant difference in Sp O₂ among the 3 groups at different postoperative time points（P>0.05）.The analgesic recovery rate in groupⅡand groupⅢwere lower than that in groupⅠ（P<0.05）,and the incidence of nausea and vomiting in group Ⅲ was higher than that in groupⅠand groupⅡ（P<0.05）.Conclusion Fentanyl 10.0 μg/kg+tropisetron 0.1 mg/kg+dexmedetomidine hydrochloride 2 μg/kg diluted with saline and PCIA pump intravenous continuous infusion has good postoperative analgesia and high safety.It is worthy of clinical application.更多还原