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目的:研究不同剂量舒芬太尼和吗啡对小儿先天性心脏病手术后的镇痛镇静效果以及安全性评价。方法:前瞻性选取2014年10月~2015年10月在本院心胸外科进行小儿心脏手术治疗的A患儿120例,随机分为4组,分别为舒芬太尼1组(SI)、舒芬太尼2组(SII)、舒芬太尼3组(SIII)以及吗啡组(M),每组30例。SI组术后镇痛选择舒芬太尼0.03μg/(kg·h),SII组舒芬太尼的量为0.04μg/(kg·h),SIII组舒芬太尼0.05μg/(kg·h),M组采用吗啡15μg/(kg·h),各组都加用咪达唑仑,剂量为2μg/(kg·min)。分别在术后1,4,8,12,24,48h进行镇痛、Ramsay镇静评分,记录心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SPO2),并对出现不良反应及追加咪达唑仑镇静药物的次数进行比较。结果:术后各时间点M组的镇痛及镇静的满意度较SI、SII、SIII组明显降低,差异具有统计学意义;四组患儿的生命体征结果中,M组与其他组相比,HR、MAP、RR以及SPO2在各个时间点无明显差异。各组的不良反应情况无统计学差异,但M组与其他组相比,需要镇静剂的人次明显增多,差异具有统计学意义。结论:舒芬太尼与吗啡相比,用于小儿先天性心脏病术后镇痛镇静效果更佳。当剂量为舒芬太尼0.05μg/(kg·h)+咪达唑仑2μg/(kg·min)时,不良反应较少,且追加咪达唑仑的发生率较低。
Objective: To study the analgesic and sedation effect and safety evaluation of sufentanil and morphine in children after congenital heart disease surgery. METHODS: A prospective study of 120 children with A who underwent cardiac surgery in our hospital from October 2014 to October 2015 were randomly divided into 4 groups: sufentanil group 1 (SI), Shu Fentanyl group 2 (SII), sufentanil group 3 (SIII) and morphine group (M), 30 cases in each group. Sufentanyl 0.03μg / (kg · h), sufentanil 0.04μg / (kg · h) in SII group and sufentanil 0.05μg / (kg · h). M group used morphine 15μg / (kg · h), midazolam plus 2μg / (kg · min). Analgesia, Ramsay sedation score, heart rate (HR), mean arterial pressure (MAP), respiration rate (RR) and oxygen saturation (SPO2) were measured at 1,4,8,12,24,48h after operation. The number of adverse reactions and additional medications sedated with midazolam were compared. Results: The postoperative analgesic and sedation satisfaction of M group was significantly lower than that of SI, SII and SIII group, the difference was statistically significant; Among the four groups of children’s vital signs results, M group compared with other groups HR, MAP, RR and SPO2 were not significantly different at all time points. Adverse reactions in each group had no statistical difference, but M group compared with other groups, the need for sedation increased significantly, the difference was statistically significant. CONCLUSIONS: Sufentanil is more effective than morphine in postoperative analgesia and sedation in children with congenital heart disease. When the dose was sufentanil 0.05μg / (kg · h) + midazolam 2μg / (kg · min), the adverse reactions were less, and the incidence of additional midazolam was lower.