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目的:探讨舒芬太尼静脉输注用于小儿尿道修复术后镇痛的最低有效剂量。方法:纳入2～4岁行尿道下裂修复手术的小儿,在吸入诱导下行单次骶管阻滞(0.25%罗哌卡因1mL/kg),术中静脉输注丙泊酚50μg/(kg·min)维持小儿镇静。静脉注射舒芬太尼0.1μg/kg后,静脉通路连接镇痛泵,以2mL/h速度持续输注舒芬太尼,采用改良序贯法选择舒芬太尼剂量。盲法评估小儿术后1、4、8、24、48h疼痛和镇静效果,并记录不良反应。结果:共观察40例小儿,仅有1例术后8h出现轻度恶心,没有发生呼吸抑制和皮肤瘙痒。舒芬太尼剂量为2、1μg/(kg·d)和0.75μg/(kg·d)时,所有小儿镇痛效果良好。舒芬太尼剂量为0.5μg/(kg·d)时,术后有4例小儿需要追加镇痛药物。结论:2～4岁小儿尿道下裂修复术后,舒芬太尼静脉镇痛的最低有效剂量为0.75μg/(kg·d)。
Objective: To investigate the minimum effective dose of sufentanil for postoperative analgesia of pediatric urethral prostheses. Methods: A single caudal block (0.25% ropivacaine 1 mL / kg) was infused in children aged 2 to 4 years who underwent hypospadias repair. Intravenous infusion of propofol 50 μg / kg · Min) to maintain pediatric sedation. After intravenous injection of sufentanil 0.1μg / kg, intravenous analgesia pump was connected to sufentanil continuously at a rate of 2mL / h. Sufentanil dose was selected by modified sequential method. Blind evaluation of pediatric 1,4,8,24,48 h after pain and sedation, and record adverse reactions. Results: A total of 40 children were observed. Only 1 patient developed mild nausea at 8h after operation. No respiratory depression and skin pruritus occurred. Sufentanil at doses of 2,1μg / (kg · d) and 0.75μg / (kg · d), all pediatric analgesic effect is good. Sufentanil dose of 0.5μg / (kg · d), postoperative 4 children need additional analgesics. CONCLUSIONS: The minimum effective dose of sufentanil intravenous analgesia after hypospadias repair in children aged 2 to 4 years is 0.75μg / (kg · d).