發(fā)布時間：2019-06-17 21:31

【摘要】：目的比較氟比洛芬酯超前鎮(zhèn)痛復(fù)合不同劑量舒芬太尼對小兒骨盆截骨矯形術(shù)術(shù)后鎮(zhèn)痛的效果,尋找適合小兒的術(shù)后鎮(zhèn)痛模式。方法:選取我院小兒骨科3～10歲的先天性髖脫位,擬于全麻下行骨盆截骨矯形術(shù)患兒90例,根據(jù)氟比洛芬酯復(fù)合舒芬太尼劑量的不同,將患兒隨機(jī)分為N1、N2、N3三組。三組PCA舒芬太尼的劑量分別為1.5、2.0或2.5 u g/kg,三組切皮前均給予靜脈注射氟比洛芬酯1mg/kg超前鎮(zhèn)痛。PCA泵中昂丹司瓊含量均為0.1mg/kg,容量加生理鹽水至100毫升。記錄各組患兒在恢復(fù)室的氣管插管拔除時間,患兒術(shù)后2、4、8、12、24、48h各個時間點的FLACC疼痛評分,術(shù)后48h內(nèi)PCA按壓次數(shù)、Ramsay鎮(zhèn)靜評分,惡心、嘔吐、呼吸抑制等不良反應(yīng)等。結(jié)果三組患兒在恢復(fù)室的術(shù)后拔管時間差異無統(tǒng)計學(xué)意義(P0.05)。FLACC評分比較,術(shù)后4,8和12h,N2組、N3組明顯低于N1組,差異有統(tǒng)計學(xué)意義(P0.05),N3組低于N2組,差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后24和48h,N3組低于N1組差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)后48hPCA泵按壓次數(shù),N1組13次,N2組7次,N3組3次,差異有統(tǒng)計學(xué)意義(P0.05)。Ramsay評分比較,術(shù)后4,8和12h,N2組和N3組明顯高于于N1組,差異有統(tǒng)計學(xué)意義(P0.05),術(shù)后24和48h,N3組高于N1組差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)后48h惡心,嘔吐發(fā)生率N3組(8例)明顯高于N1組(0例)和N2組(3例),差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論氟比洛芬酯1mg/kg超前鎮(zhèn)痛復(fù)合舒芬太尼2 μ g/kg是一種理想的小兒骨盆截骨矯形術(shù)的PCA模式。
[Abstract]:Objective to compare the effect of preemptive analgesia combined with different doses of sufentanil on postoperative analgesia after pelvic osteotomy and orthopaedic surgery in children, and to find a suitable postoperative analgesia mode for children. Methods: 90 children undergoing pelvic osteotomy and orthopaedic surgery under general anesthesia were randomly divided into three groups: N1 group, N2 group and N3 group according to the dose of flubiprofen ester combined with sufentanil. The doses of sufentanil in the three groups were 1.5, 2.0 or 2.5 渭 g 路kg ~ (- 1), respectively. all the three groups were treated with flubiprofen ester 1mg/kg preemptive analgesia before skin incision. The content of ondansetron in the three groups was 0.1 mg 路kg ~ (- 1), and the volume was added to 100ml of saline. The extubation time of tracheal intubation in recovery room was recorded. FLACC pain score, PCA pressing times, Ramsay sedation score, nausea, vomiting, respiratory suppression and other adverse reactions were recorded at each time point at 2, 4, 8, 12, 24 and 48 hours after operation. Results there was no significant difference in extubation time between the three groups (P 0.05). FLACC score in N2 group and N3 group was significantly lower than that in N1 group at 4, 8 and 12 hours after operation (P 0.05), N3 group was lower than N2 group, the difference was statistically significant (P 0.05). 24 and 48 hours after operation, N3 group was significantly lower than N1 group (P 0.05). The number of 48hPCA pump pressing was 13 times in N1 group, 7 times in N2 group and 3 times in N3 group, the difference was statistically significant (P 0.05). Ramsay score was significantly higher in N2 group and N3 group than that in N1 group at 4, 8 and 12 hours after operation, the difference was statistically significant (P 0.05). 24 and 48 hours after operation, the difference between N3 group and N1 group was statistically significant (P 0.05). 48 hours after operation, the incidence of nausea and vomiting in N3 group (8 cases) was significantly higher than that in N1 group (0 cases) and N2 group (3 cases), the difference was statistically significant (P 0.05). Conclusion 1mg/kg preemptive analgesia combined with sufentanil 2 渭 g/kg is an ideal PCA model for pelvic osteotomy and orthopaedic surgery in children.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.1

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