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1、瑞芬太尼及芬太尼对小儿斜视纠正术术后恶心呕吐及疼痛影响对比探究【摘要】目的对比短时效阿片类药物-瑞芬太尼与芬太尼对小儿斜视术后呕吐和疼痛的作用的差别。方法60名ASAI～II级,2～12岁择期在全麻下行斜视纠正术的小儿,随机分为两组,R组(瑞芬太尼)与F组(芬太尼)。术后记录25h呕吐事件。苏醒后60min记录疼痛评分。结果两组术后呕吐发生率没有统计学差异(49%vs48%)。但是R组术后呕吐频率较F组低(0.95vs2.2)。苏醒后头30min,F组术后疼痛评分较低。结论平衡全麻下小儿斜视术后,瑞芬太尼组术后呕吐发生频率较
2、少,但芬太尼组对术后早期镇痛效果较好。【关键词】瑞芬太尼;芬太尼;术后恶心呕吐;疼痛;斜视手术AcomparisonofremifentanilandfentanylforpostoperativevomitingandpainafterstrabismussurgeryCHENYing,LIAOZhijie,CHENQianru,etal.DepartmentofAnesthesiology,ZhongshanOphthalmologyCeaterofZhongsshanUniversityGuangzhou510600,
3、China【Abstract】ObjectiveTocomparetheeffectof7remifentanilwithfentanylonpostoperativevomitingandpaininchildrenundergoingstrabismussurgery.Methods60ASAstatusIorIIchildrenfrom2~12yearsundergoingelectivestrabismussurgeryundergeneralanesthesia.Childrenwererandomizedtore
4、ceiveeitherremifentanil(GroupR)orfentanyl(GroupF).POVepisodeswererecordedfor25hour.painscoreswereobtainedbyusinganobjectivepainscalefor60minduringrecovery.ResultsThenumberofpatientswhoexperiencedPOVdidnotdiffersignificantlybetweengroups(49%vs48%).However,inthegroup
5、R,POVepisodesweresignificantlylessfrequent(0.95vs2.2).Incontrast,fentanylwasassociatedwithlowerpainscoresduringthefirst30minofrecovery.ConclusionChildundergoingstrabismussurgeryunderbalancedanesthesiawithremifentanil,comparedwithfentanyl,showslessfrequentPOV.Howeve
6、r,earlypostoperativeanalgesiaisbetterwithfentanyl.【Keywords】Remifentanil;Fentanyl;PONV;Pain;Strabismussurgery7小儿行斜视术后常出现呕吐。由于不同麻醉技术、抗呕吐治疗及手术时间和类型、患者个体差异的差别,发生率为15%～75%[1]。术后恶心呕吐增加患者痛苦,增加住院率[2]。围术期阿片类药物的应用显著增加了术后呕吐的发生,且与剂量有关[3]。小儿斜视纠正术,静脉应用吗啡诱导较酮络酸术后呕吐发生率明显增加(71%vs9
7、%)[4]。瑞芬太尼具有酯键,因而结构独特。酯键易被血和组织中的非特异性酯酶消解,导致其代谢迅速,时-量相关半衰期3～4min。与长效阿片类药物相比,瑞芬太尼超短半衰期的特点对小儿斜视术后呕吐发生率的影响尚未明确。本研究旨在对比瑞芬太尼与芬太尼对术后呕吐及疼痛的影响,以寻找小儿斜视手术的最佳麻醉药物。1资料与方法1.1一般资料60例ASAI～II级择期行斜视纠正术小儿,年龄2～12岁(男42例,女39例),随机分为两组:R组(瑞芬太尼)和F组(芬太尼)。有术后呕吐病史、运动疾病或恶性高热高危人群排除在外。1.2治疗方法患儿术
8、前口服咪唑安定0.4mg/kg(最大剂量10mg)。建立静脉通道后,监测ECG、NIBP、SO2,静脉注射阿托品10μg/kg。根据Song等[5]和Guy等[6]的研究确定瑞芬太尼和芬太尼的用量。瑞芬太尼诱导量1μg/kg,静脉注射时间2min,以0.27μg/kg/min维持,切皮后降
