本文選題：舒芬太尼　切入點：嗎啡　出處：《重慶醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：本研究旨在比較不同劑量舒芬太尼和嗎啡對先天性心臟病手術后鎮(zhèn)痛的臨床效果及不良反應，為舒芬太尼廣泛用于幼兒術后鎮(zhèn)痛提供合適的用藥依據(jù)。 方法：前瞻性研究，選取重慶醫(yī)科大學附屬兒童醫(yī)院心胸外科2011年11月至2012年3月期間在體外循環(huán)+全身麻醉下完成的ASAI-II級120例先天性心臟病手術患者，采用單盲方法隨機分為4組，舒芬太尼1組（S1），舒芬太尼2組（S2），舒芬太尼3組（S3），嗎啡組（M），每組30例。術后入重癥監(jiān)護室連接鎮(zhèn)痛泵開始持續(xù)鎮(zhèn)痛，S1組給予舒芬太尼維持劑量0.03g·kg-1·h-1+咪達唑倫2g·kg-1·min-1；S2組給予舒芬太尼維持劑量0.04g·kg-1·h-1+咪達唑倫2g·kg-1·min-1；S3組給予舒芬太尼維持劑量0.05g·kg-1·h-1+咪達唑倫2g·kg-1·min-1；M組給予嗎啡維持劑量15g·kg-1·h-1+咪達唑倫2g-1·kg-1·min-1。于術后1，4，8，12，24h進行面部表情疼痛評分、Ramsay鎮(zhèn)靜評分，持續(xù)監(jiān)測心率(heartrate,HR)、平均動脈壓(mean arterial pressure,MAP)、血糖(bloodsuger,BS)、血乳酸(lactate concentration,Lac)、血清皮質醇(cortisol,Cor)的含量，并對各組出現(xiàn)惡心、嘔吐、皮疹的不良反應次數(shù)及臨時追加咪達唑侖鎮(zhèn)靜藥物的次數(shù)進行觀察和比較。統(tǒng)計學處理：計量資料以均數(shù)±標準差表示，組間計量資料比較采用單因素方差分析，計數(shù)資料采用卡方檢驗，P＜0.05為差異有統(tǒng)計學意義。采用GraphPad Prism5程序繪制圖表并比較。 結果：與M組相比，S1、S2、S3組在術后1h鎮(zhèn)痛、鎮(zhèn)靜滿意度顯著升高，其余各時點4組無明顯差異；M組需臨時追加鎮(zhèn)靜藥物人次明顯增多；4組患兒在術后1h及4h血清皮質醇水平均顯著高于正常生理水平（p＜0.05），M組在術后1h點血清皮質醇較其余3組明顯增高；4組間HR、RR、MAP、BS、Lac及術后不良反應均無明顯差異。 結論：舒芬太尼用于先天性心臟病術后患兒鎮(zhèn)痛效果優(yōu)于嗎啡，舒芬太尼0.03g·kg-1·h-1至0.05g·kg-1·h-1劑量范圍復合咪達唑侖2g·kg-1·min-1均能達到滿意鎮(zhèn)痛效果。舒芬太尼0.05g·kg-1·h-1復合咪達唑侖2g·kg-1·min-1不良反應少，需臨時需追加鎮(zhèn)靜藥物少，為小兒術后鎮(zhèn)靜的安全理想藥物組合。
[Abstract]:Objective: to compare the clinical effects and adverse reactions of different doses of sufentanil and morphine on postoperative analgesia of congenital heart disease. Methods: a prospective study was conducted on 120 patients with ASAI-II grade congenital heart disease who underwent cardiothoracic surgery under general anesthesia under cardiopulmonary bypass from November 2011 to March 2012 in the Children's Hospital affiliated to Chongqing Medical University. A single blind method was used to divide into 4 groups at random. Sufentanil, sufentanil, sufentanil, sufentanil, sufentanil, sufentanil, and morphine, 30 patients in each group, respectively. The group S 1 was given sufentanil at a maintenance dose of 0.03 g 路kg-1 路h -1 midazolone 2 g 路kg-1 路min -1 after operation. The maintenance dose of sufentanil was 0.04g 路kg-1 路h-1 midazolam 2g 路kg-1 路min-1C S3. The maintenance dose of sufentanil was 0.05g 路kg-1 路h-1 midazolone 2g 路kg-1 路min-1. The morphine maintenance dose was 15g 路kg-1 路h-1 midazolam 2g-1 路kg-1 路min-1. Continuous monitoring of heart rate and heart rate, mean arterial pressure, mean arterial pressure MAPP, blood sugar and blood sugersBSU, lactate lactate concentration, serum cortisol, and nausea and vomiting in each group. The number of adverse reactions of skin rash and the times of temporary addition of midazolam sedation were observed and compared. Statistical analysis: the metrological data were expressed as mean 鹵standard deviation, and the measurement data were compared by single factor ANOVA. There was significant difference in counting data by chi-square test (P < 0. 05). The chart was drawn by GraphPad Prism5 program and compared. Results: compared with M group, the analgesia and sedation satisfaction were significantly increased in group S _ 1 and S _ 2 + S _ 3 at 1 h after operation. There was no significant difference among the other four groups at other time points. The need for temporary sedation in group M was significantly increased. The serum cortisol levels in group 4 were significantly higher than those in normal physiological level at 1 h and 4 h after operation, p < 0. 05 and P < 0. 05 respectively. At 1 h after operation, the levels of serum cortisol in group M were significantly higher than those in group 1. There was no significant difference between the other three groups in HRN RRN MAPP BSU Lac and postoperative adverse reactions. Conclusion: the analgesic effect of sufentanil in postoperative children with congenital heart disease is better than that of morphine. The analgesic effect of sufentanil 0.03g 路kg-1 路h-1 to 0.05g 路kg-1 路h-1 combined with midazolam 2g 路kg-1 路min-1 can achieve satisfactory analgesic effect, sufentanil 0.05g 路kg-1 路h-1 combined with midazolam 2g 路kg-1 路min-1 has less adverse reactions. It is a safe and ideal combination of sedation for pediatric postoperative sedation.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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