發(fā)布時(shí)間：2018-03-28 08:21

  本文選題：右美托咪定　切入點(diǎn)：芬太尼　出處：《上海醫(yī)學(xué)》2015年08期

【摘要】：目的觀察右美托咪定復(fù)合芬太尼患者靜脈自控鎮(zhèn)痛(PCIA)應(yīng)用于小兒鼾癥術(shù)后鎮(zhèn)痛的安全性和有效性。方法行鼾癥手術(shù)的患兒120例,美國(guó)麻醉醫(yī)師協(xié)會(huì)(ASA)分級(jí)Ⅰ或Ⅱ級(jí),隨機(jī)分入芬太尼小劑量組、芬太尼大劑量組、右美托咪定+芬太尼小劑量組和右美托咪定+芬太尼大劑量組,每組30例。術(shù)后均給予PCIA:芬太尼小劑量組為芬太尼6μg/kg+恩丹西酮50μg/kg,芬太尼大劑量組為芬太尼8μg/kg+恩丹西酮50μg/kg,右美托咪定+芬太尼小劑量組為右美托咪定1.25μg/kg+芬太尼6μg/kg+恩丹西酮50μg/kg,右美托咪定+芬太尼大劑量組為右美托咪定1.25μg/kg+芬太尼8μg/kg+恩丹西酮50μg/kg,各組均加0.9%氯化鈉溶液稀釋至100mL;負(fù)荷量均為芬太尼1μg/kg;背景劑量為4mL/h,單次給藥1mL,鎖定時(shí)間為15min。觀察4組患兒術(shù)后的心率(HR)、收縮壓(SBP)、舒張壓(DBP)、呼吸頻率(RR)、脈搏血氧飽和度(SpO2)、疼痛視覺(jué)模擬評(píng)分(VAS評(píng)分)、Ramsay鎮(zhèn)靜評(píng)分,以及不良反應(yīng)的發(fā)生情況。結(jié)果各組間在術(shù)后2、4、6h的HR、SBP、DBP、RR的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05),SpO2均95%。芬太尼大劑量組、右美托咪定+芬太尼小劑量組、右美托咪定+芬太尼大劑量組在術(shù)后4、8h的疼痛VAS評(píng)分均顯著低于芬太尼小劑量組,Ramsay鎮(zhèn)靜評(píng)分均顯著高于芬太尼小劑量組(P值均0.05);右美托咪定+芬太尼小劑量組、右美托咪定+芬太尼大劑量組在術(shù)后4、8h的疼痛VAS評(píng)分均顯著低于芬太尼大劑量組,Ramsay鎮(zhèn)靜評(píng)分均顯著高于芬太尼大劑量組(P值均0.05);右美托咪定+芬太尼大劑量組在術(shù)后4、8h的疼痛VAS評(píng)分均顯著低于右美托咪定+芬太尼小劑量組(P值均0.05),Ramsay鎮(zhèn)靜評(píng)分均顯著高于右美托咪定+芬太尼小劑量組(P值均0.05);4組間在術(shù)后12、24h的疼痛VAS評(píng)分和Ramsay鎮(zhèn)靜評(píng)分的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。芬太尼大劑量組、右美托咪定+芬太尼小劑量組、右美托咪定+芬太尼大劑量組術(shù)后12h內(nèi)的PCIA按壓次數(shù)均顯著少于芬太尼小劑量組(P值均0.05),右美托咪定+芬太尼小劑量組、右美托咪定+芬太尼大劑量組均顯著少于芬太尼大劑量組(P值均0.05),右美托咪定+芬太尼大劑量組顯著少于右美托咪定+芬太尼小劑量組(P0.05),4組間術(shù)后12~24h的PCIA按壓次數(shù)的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。4組均未發(fā)生心動(dòng)過(guò)緩、呼吸抑制和皮膚瘙癢,但右美托咪定+芬太尼大劑量組出現(xiàn)過(guò)度鎮(zhèn)靜現(xiàn)象,芬太尼小劑量組發(fā)生惡心嘔吐3例,芬太尼大劑量組發(fā)生惡心嘔吐6例,右美托咪定+芬太尼小劑量組和右美托咪定+芬太尼大劑量組均無(wú)惡心嘔吐發(fā)生。結(jié)論右美托咪定復(fù)合小劑量芬太尼用于小兒鼾癥術(shù)后PCIA的效果確切,安全可靠,且不良反應(yīng)少,值得臨床推廣。
[Abstract]:Objective to observe the safety and efficacy of dexmetomidine combined with fentanyl for postoperative analgesia in children with snoring. They were randomly divided into fentanyl low-dose group, fentanyl high-dose group, dexmetomidine fentanyl low-dose group and dexmetomidine fentanyl high-dose group. Each group was given PCIA: fentanyl 6 渭 g/kg ondansetron 50 渭 g / kg in low dose group, fentanyl 8 渭 g/kg ondansetron 50 渭 g / kg in fentanyl high dose group, dexmetomidine 1.25 渭 g/kg fentanyl 6 渭 g/kg in low dose group. Dansetron 50 渭 g / kg, dexmetomidine 1.25 渭 g/kg fentanyl 8 渭 g/kg ondansetron 50 渭 g / kg, each group diluted to 100mL with 0.9% sodium chloride solution; loading dose of fentanyl was 1 渭 g / kg; background dose was 4 mL / h, single dose was 1 mL / kg, lock time. The HR, SBP, DBP, RRV, SPO _ 2, VAS and Ramsay sedation were observed in the four groups. Results there was no significant difference in DBP RR between the two groups at 2: 4 and 6 hours after operation (P = 0.05) and SPO _ 2 _ (95). Fentanyl group with high dose and low dose group with dexmetidine fentanyl, with high dose of fentanyl, with low dose of fentanyl, no significant difference was found between the two groups. The pain VAS scores of high dose group were significantly lower than those of fentanyl low dose group (P < 0.05), and that of dexmetidine low-dose fentanyl group were significantly higher than those of fentanyl low-dose group, and that of fentanyl low-dose group were significantly higher than those of fentanyl low-dose group. The pain VAS scores in the high-dose group were significantly lower than those in the fentanyl high-dose group at 4 h after the operation (P < 0.05), and those in the high-dose fentanyl group were significantly higher than those in the fentanyl high-dose group (P < 0.05). The pain VAS scores at 4 h after operation were significantly lower than those in the low dose group of dexmetomidine fentanyl (P < 0.05) and Ramsay sedation scores were significantly higher than those in the low dose group (n = 0.05) and the VAS scores of pain at 24 h after operation. The difference of Ramsay sedation score was not statistically significant (P = 0.05). Fentanyl high dose group, fentanyl group, fentanyl group, fentanyl high dose group, The times of PCIA compression in low dose group and high dose group were significantly lower than those in fentanyl low dose group and low dose fentanyl group, and the number of times of PCIA compression in high dose group was significantly lower than that in fentanyl small dose group, and that in dexmetomidine fentanyl low dose group was lower than that in fentanyl low dose group. The high dose group of fentanyl was significantly less than that of fentanyl group (P < 0.05), and the high dose group of fentanyl was significantly less than that of the low dose group of dexmetomidine fentanyl group (P < 0.05). There was no significant difference in the number of bradycardia between the two groups (P < 0.05 or P = 0.05 or P = 0.05), and no bradycardia was found in all the groups. Respiratory inhibition and pruritus were observed, but excessive sedation was found in the high dose group of fentanyl, nausea and vomiting in 3 cases in the low dose group, nausea and vomiting in 6 cases in the high dose group of fentanyl. There was no nausea and vomiting in low dose group and high dose group. Conclusion the effect of dexmetomidine combined with low dose fentanyl on postoperative PCIA in children with snoring is effective, safe and reliable. And the adverse reaction is few, it is worth popularizing clinically.
【作者單位】： 武漢市婦女兒童醫(yī)療保健中心;
【分類號(hào)】：R726.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 甄素蘭;胸部手術(shù)后靜脈自控鎮(zhèn)痛的臨床觀察[J];長(zhǎng)治醫(yī)學(xué)院學(xué)報(bào);2002年03期

2 許峰,徐旭仲,胡明品,金勝威,連慶泉;術(shù)前預(yù)用羅非昔布對(duì)術(shù)后病人靜脈自控鎮(zhèn)痛效果的影響[J];中華麻醉學(xué)雜志;2004年05期

3 毛尚平;靜脈自控鎮(zhèn)痛在外傷所致疼痛中的應(yīng)用[J];淮海醫(yī)藥;2004年05期

4 張暾;不同劑量芬太尼術(shù)后靜脈自控鎮(zhèn)痛療效觀察[J];浙江臨床醫(yī)學(xué);2005年04期

5 王華;趙純;王瑋;;靜脈自控鎮(zhèn)痛法用于神經(jīng)外科頭部手術(shù)患者鎮(zhèn)痛的臨床體會(huì)[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2008年09期

6 常向陽(yáng);王立中;姚明;姚康珍;湯蓓蕾;;產(chǎn)科病人術(shù)后靜脈自控鎮(zhèn)痛效應(yīng)與婦科手術(shù)病人的比較[J];全科醫(yī)學(xué)臨床與教育;2009年02期

7 王培山;孫振濤;;不同劑量舒芬太尼用于兒童術(shù)后靜脈自控鎮(zhèn)痛效果觀察[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2010年03期

8 劉寶東;支修益;許慶生;張毅;蘇雷;王若天;胡牧;劉磊;錢坤;;肺葉切除術(shù)患者術(shù)后肋間神經(jīng)冷凍止痛與靜脈自控鎮(zhèn)痛效果的比較[J];中國(guó)胸心血管外科臨床雜志;2010年04期

9 彭永明;薛廣燕;連芳;;右旋美托咪啶在腹腔鏡膽囊切除術(shù)后靜脈自控鎮(zhèn)痛中的應(yīng)用[J];南昌大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2011年03期

10 宋愛軍;楊寶芬;李美;苑學(xué);于軍;何靜;張艷紅;李向民;薛桂娟;;靜脈自控鎮(zhèn)痛對(duì)術(shù)后產(chǎn)婦身心的影響[J];職業(yè)與健康;2011年17期

相關(guān)會(huì)議論文 前10條

1 曹淑萍;楊小榮;劉明洲;張菊蓮;;靜脈自控鎮(zhèn)痛術(shù)效果欠佳原因分析[A];寧夏醫(yī)學(xué)會(huì)麻醉學(xué)分會(huì)第二屆學(xué)術(shù)會(huì)議論文匯編[C];2004年

2 王文偉;徐衛(wèi)平;;剖宮產(chǎn)術(shù)后布拉諾復(fù)合芬太尼靜脈自控鎮(zhèn)痛的應(yīng)用研究[A];2005年浙江省麻醉學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2005年

3 鄭書嬌;;布拉諾+芬太尼用于剖宮產(chǎn)術(shù)后靜脈自控鎮(zhèn)痛的臨床觀察[A];2004年浙江省麻醉學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2004年

4 劉惠君;吳家虹;;肛門會(huì)陰術(shù)后患者靜脈自控鎮(zhèn)痛的臨床研究[A];大腸肛門病論文匯編[C];2001年

5 邵雪泉;余功敏;;舒芬太尼在腹腔鏡膽囊切除術(shù)后靜脈自控鎮(zhèn)痛的應(yīng)用[A];浙江省醫(yī)學(xué)會(huì)疼痛學(xué)分會(huì)成立大會(huì)暨首屆浙江省醫(yī)學(xué)會(huì)疼痛學(xué)分會(huì)學(xué)術(shù)年會(huì)論文匯編[C];2011年

6 馮慧悅;祝勝美;;靜脈自控鎮(zhèn)痛對(duì)肝硬化門脈高壓患者門奇靜脈斷流術(shù)后凝血功能的影響[A];2007年浙江省麻醉學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

7 劉惠君;吳家虹;;氯諾昔康在肛門病術(shù)后患者靜脈自控鎮(zhèn)痛的應(yīng)用[A];中西醫(yī)結(jié)合大腸肛門病研究新進(jìn)展——第十屆中國(guó)中西醫(yī)結(jié)合學(xué)會(huì)大腸肛門病學(xué)術(shù)研討會(huì)論文集[C];2004年

8 張衛(wèi);李治松;;瑞芬太尼用于產(chǎn)婦分娩靜脈自控鎮(zhèn)痛進(jìn)展[A];2006年中華醫(yī)學(xué)會(huì)全國(guó)麻醉學(xué)術(shù)年會(huì)知識(shí)更新講座[C];2006年

9 王佳;張維峰;張春明;;舒芬太尼在肝炎產(chǎn)婦剖宮產(chǎn)術(shù)后靜脈自控鎮(zhèn)痛中的應(yīng)用[A];中華醫(yī)學(xué)會(huì)全國(guó)新發(fā)和再發(fā)傳染病2012年學(xué)術(shù)研討會(huì)論文匯編[C];2012年

10 安肖霞;趙抗美;溫小紅;;恩丹西酮對(duì)曲馬多術(shù)后病人靜脈自控鎮(zhèn)痛療效的影響[A];2004年浙江省麻醉學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2004年

相關(guān)碩士學(xué)位論文 前5條

1 劉曉;成人開腹手術(shù)術(shù)后靜脈自控鎮(zhèn)痛芬太尼消耗量的影響因素分析[D];廣西醫(yī)科大學(xué);2013年

2 蘇靖誠(chéng);不同劑量舒芬太尼用于開腹手術(shù)后靜脈自控鎮(zhèn)痛的效果比較[D];廣西醫(yī)科大學(xué);2015年

3 胡海游;簡(jiǎn)化版的McGill疼痛問(wèn)卷表（SF-MPQ）在術(shù)后靜脈自控鎮(zhèn)痛的應(yīng)用[D];中南大學(xué);2014年

4 唐軼洋;舒芬太尼與芬太尼術(shù)后靜脈自控鎮(zhèn)痛的系統(tǒng)評(píng)價(jià)[D];廣州中醫(yī)藥大學(xué);2013年

5 孫艷斌;右美托咪定聯(lián)合舒芬太尼在開胸手術(shù)術(shù)后病人靜脈自控鎮(zhèn)痛的應(yīng)用[D];大連醫(yī)科大學(xué);2014年

，

本文編號(hào)：1675512