本文關(guān)鍵詞： 氫嗎啡酮 術(shù)后鎮(zhèn)痛 靜脈 小兒　出處：《蘭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究氫嗎啡酮在小兒發(fā)育性髖關(guān)節(jié)脫位矯形術(shù)后靜脈鎮(zhèn)痛中的應(yīng)用,評價其有效性及安全性。方法:采用隨機(jī)、雙盲、平行陽性對照的研究方法。納入75例2~5歲全身麻醉下行發(fā)育性髖關(guān)節(jié)脫位矯形術(shù)的患兒,隨機(jī)分為舒芬太尼組(S組)和氫嗎啡酮組(H組),S組38例,H組37例。使用相同的麻醉方案。兩組患兒手術(shù)結(jié)束前分別單次靜脈注射舒芬太尼0.1μg/kg或氫嗎啡酮10μg/kg,氣管拔管后均接受術(shù)后48小時父母控制靜脈鎮(zhèn)痛治療。S組背景劑量0.04μg·kg-1·h-1,單次沖擊劑量0.01μg/kg,H組背景劑量4μg·kg-1·h-1,單次沖擊劑量1ug/kg,兩組鎮(zhèn)痛泵藥液均配置到100ml、輸注速度為2ml/h、單次沖擊劑量0.5ml、鎖定時間15min、持續(xù)輸注48h。通過蘇醒期嗆咳、躁動評分、生命體征變化,術(shù)后不同時間點(diǎn)疼痛評分、血清P物質(zhì)、鎮(zhèn)靜評分、阿片類藥物消耗量及鎮(zhèn)痛泵的按壓次數(shù)、父母滿意度評分、不良反應(yīng)和不良事件發(fā)生率評估其臨床有效性及安全性。結(jié)果:蘇醒期H組平均動脈壓高于S組(P0.05),睜眼時H組Narcotrend值低于S組(P0.05),兩組患兒躁動與嗆咳發(fā)生率組間差異無統(tǒng)計學(xué)意義(P0.05),拔管時間和蘇醒時間組間差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后鎮(zhèn)痛期H組T5、T6、T7時間點(diǎn)鎮(zhèn)靜效果較強(qiáng),組間差異具有統(tǒng)計學(xué)意義(P0.05),H組無效按壓次數(shù)較S組多(P0.05),有效按壓次數(shù)及患兒家屬滿意度組間差異無統(tǒng)計學(xué)差異(P0.05),疼痛評分與血清P物質(zhì)兩組間差異無統(tǒng)計學(xué)意義(P0.05);兩組患兒不良反應(yīng)及不良事件發(fā)生率組間差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:與等效劑量舒芬太尼相比,氫嗎啡酮10μg/kg手術(shù)結(jié)束前單次靜脈注射有助于麻醉蘇醒期平穩(wěn)恢復(fù),維持生命體征平穩(wěn)。氫嗎啡酮背景劑量4μg·kg-1·h-1,單次沖擊劑量1μg/kg可以作為一個新的治療選擇用于小兒骨科手術(shù)后父母控制靜脈鎮(zhèn)痛,安全有效,但需注意其術(shù)后早期鎮(zhèn)靜效果可能較舒芬太尼強(qiáng)。
[Abstract]:Objective: to study the efficacy and safety of hydromorphone in intravenous analgesia after orthopedic surgery for developmental dislocation of the hip in children. Methods: a study of 75 children with developmental dislocation of the hip under general anesthesia at the age of 2 to 5 years was included in a parallel positive control study. They were randomly divided into sufentanil group (group S) and hydromorphine group (group H, n = 38) and group H (n = 38). The same anesthesia was used in both groups. Sufentanil (0.1 渭 g / kg) or hydromorphine (10 渭 g / kg) was injected intravenously before the end of operation in both groups. The background dose was 0.04 渭 g 路kg-1 路h-1in group S, the background dose was 4 渭 g 路kg-1 路h-1 in group H, and the dose was 1 渭 g 路kg-1 路h-1 in group H after 48 hours of parent-controlled intravenous analgesia. The analgesic pump solution in both groups was allocated to 100ml, the infusion rate was 2 ml / h, and the single impact dose was 1 渭 g 路kg-1 路h-1. The dose of 0.5 ml, locking time of 15 minutes, continuous infusion of 48 hours. Restlessness score, vital signs change, postoperative pain score at different time points, serum substance P, sedation score, opioid consumption, times of analgesic pump compression, parental satisfaction score, Results: the mean arterial pressure in group H was higher than that in group S during recovery, and the Narcotrend value in group H was lower than that in group S when eyes opened. The difference between the incidence of restlessness and choking in two groups was observed. There was no significant difference in the time of extubation and recovery between the two groups, and there was no significant difference in the time of extubation and recovery (P 0.05), and the sedative effect was stronger in group H at the time point of T5 and T6 and T7 during postoperative analgesia. There was no significant difference in the number of invalid compressions between the two groups. There was no significant difference in the number of effective compressions and the satisfaction of the children's family members (P 0.05). There was no significant difference between the two groups in pain score and substance P level in serum. There was no significant difference in the incidence of adverse reactions and adverse events between the two groups. Conclusion: compared with the equivalent dose of sufentanil, there was no significant difference in the incidence of adverse reactions and adverse events between the two groups. A single intravenous injection of hydromorphone 10 渭 g / kg before the end of the operation is helpful for the steady recovery during the anaesthesia recovery period. The background dose of hydromorphone was 4 渭 g 路kg-1 路h-1 and the single impact dose of 1 渭 g / kg could be used as a new therapeutic option for parent-controlled intravenous analgesia after orthopedic surgery in children. However, it should be noted that the early sedation effect may be stronger than sufentanil.
【學(xué)位授予單位】：蘭州大學(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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