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目的研究芬太尼联合表面麻醉在早产儿视网膜病激光光凝术中镇静镇痛的效果。方法收集2011年1月1日-2013年10月31日广东省妇幼保健院新生儿科收治、按照ROP国际分类标准和早产儿治疗用氧和视网膜病变防治指南标准,需行激光光凝术的125例早产儿,均已达3期阈值病变需要激光光凝术。随机分为芬太尼联合组(芬太尼联合表面麻醉组)和对照组(表面麻醉组)两组分别为61和64例。比较两组术前、手术开始后1 h、手术结束时、术后1 h、术后24 h的心率、血氧饱和度、平均动脉压,术后3天末梢微量血糖、血常规指标,C-反应蛋白、降钙素原、术后1周的胃肠道情况、术后3天的术后至出院前的颅脑影像学检查。对结果进行统计分析。结果 1芬太尼联合组术前、术中和术后1h心率为(133.7±5.2)、(143.7±4.3)和(144.2±3.3)次/分,平均动脉压为(39.5±3.4)、(41.4±2.8)和(40.5±2.7)mm Hg,血氧饱和度为(95.2±5.3)、(88.7±3.6)和(92.0±4.8)%,差异无统计学意义。表面麻醉组术前、术中和术后1h心率为(130.2±4.7)、(148.7±5.3)和(153.3±3.9)次/分,平均动脉压为(38.8±4.1)、(42.5±3.5)和(41.3±3.1)mm Hg,血氧饱和度为(94.5±3.7)、(88.7±3.6)和(92.0±4.8)%,与术前相比,差异均具有统计学意义。2芬太尼联合组术前、术后1天的白细胞为(10.8±5.4)和(13.6±5.3)×109/L,CRP为(2.90±1.4)和(3.12±2.1)mg/L,血糖为(4.40±1.2)和(4.58±1.3)mmol/L,差异均无统计学意义。表面麻醉组术前和术后1天的白细胞为(11.3±6.2)和(15.7±5.7)×109/L,CRP为(2.88±1.8)和(7.78±2.9)mg/L,差异具有统计学意义。3芬太尼联合组中术后胃储留、腹胀、呕吐、消化道出血和坏死性小肠结肠炎(NEC)发生率为16.4、13.1、21.3、3.2和1.6%,表面麻醉组为39.1、43.7、35.9、12.5、4.6%;血糖为(3.88±1.8)和(6.88±0.9)mmol/L.4芬太尼联合组和表面麻醉组分别有3例和5例颅内出血,差异无统计学意义。结论与单纯表面麻醉相比,芬太尼联合表面麻醉镇静镇痛可以减少术中术后期间患儿生命体征和血糖的波动,降低胃肠道不良反应和感染的发生,减少早产儿视网膜病激光光凝术的不良反应。
Objective To study the analgesic effect of fentanyl combined with topical anesthesia in laser photocoagulation of retinopathy of prematurity. Methods January 1, 2011 - October 31, 2013 neonatal maternity and adulthood hospital in Guangdong Province, according to the ROP international classification criteria and prenatal treatment of oxygen and retinopathy guidelines for the prevention and treatment guidelines, the need for laser photocoagulation 125 Cases of premature children, have reached the threshold of 3 lesions require laser photocoagulation. Randomly divided into fentanyl group (fentanyl joint surface anesthesia group) and the control group (surface anesthesia group) were 61 and 64 cases. The comparison of two groups before operation, 1 h after operation, at the end of operation, 1 h after operation, 24 h after operation, heart rate, oxygen saturation, mean arterial pressure, peripheral blood glucose, - reactive protein, procalcitonin, gastrointestinal tract 1 week after surgery, postoperative 3 days postoperative to brain imaging before discharge. Statistical analysis of the results. Results (1) The heart rate of 1 fentanyl group was (133.7 ± 5.2), (143.7 ± 4.3) and (144.2 ± 3.3) / minute, mean arterial pressure was (39.5 ± 3.4) 41.4 ± 2.8 and 40.5 ± 2.7 mm Hg respectively. The oxygen saturations were (95.2 ± 5.3), (88.7 ± 3.6) and (92.0 ± 4.8)%, respectively, with no significant difference. The heart rate of the topical anesthesia group was (130.2 ± 4.7), (148.7 ± 5.3) and (153.3 ± 3.9) / minute, mean arterial pressure was (38.8 ± 4.1) and (42.5 ± 3.5) And (41.3 ± 3.1) mm Hg respectively. The blood oxygen saturations were (94.5 ± 3.7), (88.7 ± 3.6) and (92.0 ± 4.8)%, respectively, which were significantly different from those before operation. 2 preoperative and postoperative day 1 white blood cells (10.8 ± 5.4) and (13.6 ± 5.3) × 109 / L, CRP was (2.90 ± 1.4) and (3.12 ± 2.1) mg / L, blood glucose (4.40 ± 1.2) and (4.58 ± 1.3) mmol / L, the difference was not statistically significant. The preoperative and postoperative day 1 white blood cells in the topical anesthesia group were (11.3 ± 6.2) and (15.7 ± 5.7) × 109 / L, with CRP of (2.88 ± 1.8) and (7.78 ± 2.9) mg / L, respectively significance. Postoperative gastric retention, bloating, vomiting, gastrointestinal bleeding and necrotizing enterocolitis (NEC) rates were 16.4, 13.1, 21.3, 3.2 and 1.6% in the fentanyl group and 39.1 and 43.7 in the topical anesthesia group , 35.9,12.5 and 4.6%, blood glucose was (3.88 ± 1.8) and (6.88 ± 0.9) mmol / L respectively. There were 3 cases and 5 cases of intracranial hemorrhage in the fentanyl group and the surface anesthesia group, respectively, with no significant difference . Conclusions Compared with simple surface anesthesia, sedation and analgesia with fentanyl combined with topical anesthesia can reduce the fluctuation of vital signs and blood glucose, reduce the incidence of gastrointestinal adverse reactions and infections, reduce the incidence of retinopathy of prematurity Adverse reactions to photocoagulation.