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目的研究不同剂量的芬太尼用于小儿术后静脉自控镇痛的临床效果。方法选择60例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级小儿骨科手术患儿,随机分为3组,每组20例,于术毕接静脉自控镇痛泵分别给予芬太尼8μg/kg(Ⅰ组)、10μg/kg(Ⅱ组)和12μg/kg(Ⅲ组),分别观察给药后4、8、12、24、48 h的镇痛评分、镇静评分及不良反应。结果Ⅰ组各时点的镇痛评分均高于Ⅱ、Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组各时点之间镇痛评分差异无统计学意义(P>0.05)。Ⅲ组各时点镇静评分高于Ⅰ、Ⅱ组,差异有统计学意义(P<0.05)。Ⅲ组术后恶心呕吐、皮肤瘙痒、尿潴留等不良反应发生率(45%)高于Ⅰ、Ⅱ组(分别为5%和10%),差异有统计学意义(P<0.05)。结论芬太尼用于小儿骨科术后病人静脉自控镇痛的安全有效剂量以10μg/kg为宜。
Objective To study the clinical effects of different doses of fentanyl for postoperative intravenous controlled analgesia in children. Methods Sixty ASA children with grade Ⅰ ~ Ⅱ pediatric orthopedic surgery were randomly divided into 3 groups (20 in each group). Patients in the control group received fentanyl 8 μg / kg (Group Ⅰ), 10 μg / kg (group Ⅱ) and 12 μg / kg (group Ⅲ). The analgesic score, sedation score and adverse reaction were observed at 4, 8, 12, 24 and 48 h after administration. Results The scores of analgesia in group Ⅰ were higher than those in groups Ⅱ and Ⅲ at each time point (P <0.05). There was no significant difference in analgesic score between groups Ⅱ and Ⅲ (P> 0.05). The sedation score in each group at the third hour was higher than that in the first and the second group, the difference was statistically significant (P <0.05). The incidence of postoperative nausea and vomiting, pruritus and urinary retention in group Ⅲ was higher than that in group Ⅰ and Ⅱ (45% vs 5% and 10%, respectively) (P <0.05). Conclusions A safe and effective dose of fentanyl for intravenous controlled analgesia in pediatric orthopedic patients is 10μg / kg.