目的 观察多模式镇痛方法在小儿扁桃体腺样体切除术后的应用效果.方法 选取在医院择期行扁桃体腺样体切除手术的90例患儿,术后均接受静脉自控镇痛(PCIA),依据随机数字表法分为3组,每组30例.给予S组舒芬太尼联合右美托咪定;给予T组酮咯酸氨丁三醇联合右美托咪定;给予ST组舒芬太尼、酮咯酸氨丁三醇联合右美托咪定.记录3组手术时间、麻醉时间;记录3组术后4、8、12、24、48 h儿童疼痛行为评估量表(FLACC)评分、Ramsay镇静评分以及48 h内PCIA的总按压次数、有效按压次数、补救镇痛及不良反应的发生情况.结果 与T组比较,术后4、8、12、24 h S组和ST组FLACC评分降低(P＜0.05).与S组比较,术后4、8、12、24、48 h T组和ST组Ramsay镇静评分降低(P＜0.05);与ST组比较,术后4、8 hT组Ramsay镇静评分降低(P＜0.05).术后48 h内T组镇痛泵总按压次数和有效按压次数多于S组和ST组(P＜0.05).术后48 h内S组恶心呕吐、嗜睡、皮肤瘙痒的发生率高于T组和ST组(P＜0.05),T组的补救镇痛率高于S组和ST组(P＜0.05).结论 舒芬太尼复合酮咯酸氨丁三醇及右美托咪定的多模式镇痛方法用于扁桃体腺样体切除术后PCIA的效果较好,不良反应发生率低.
Applacation Effect of Multimodal Analgesia in Children After Tonsillectomy and Adenoidectomy
Objective To observe the effect of multimodal analgesia in children after tonsillectomy and adenoidectomy.Methods A total of 90 children undergoing elective tonsillectomy and adenoidectomy in the hospital were selected,all accepted patient-controlled intravenous analgesia(PCIA)and were divided into 3 groups by random number table method,with 30 cases in each group.S group was given sufentanil and dexmedetomidine,and T group was given ketorolac tromethamine and dexmedetomidine,while ST group was given sufentanil,ketorolac tromethamine and dexmedetomidine.The operation time and anesthesia time of the three groups were recorded.The face,legs,activity,cry,consolability behavioral tool(FLACC)score,Ramsay sedation score at 4,8,12,24,48 hours and the total number of PCIA compressions,the number of effective compressions,remedial analgesia and the occurrence of adverse reactions within 48 hours in the three groups were recorded.Results Compared with the T group,the FLACC scores of the S group and the ST group were reduced at 4,8,12,24 hours after operation(P＜0.05).Compared with the S group,the Ramsay sedation scores of the T group and the ST group were reduced at 4,8,12,24,48 hours after the operation(P＜0.05).Compared with the ST group,the Ramsay sedation scores of the T group were reduced at 4 and 8 hours after the operation(P＜0.05).The total number of PCIA compressions and the number of effective compressions in the T group were higher than those in the S group and the ST group within 48 hours after surgery(P＜0.05).The incidence of nausea,lethargy and skin itching in the S group was higher than that in the ST group and the T group within 48 hours after surgery(P＜0.05).The salvage analgesia rate of the T group was higher than that of the S group and the ST group(P＜0.05).Conclusion Multimodal analgesia with sufentanil,ketorolac tromethamine and dexmedetomidine have satisfactory analgesic effects on PCIA after tonsillectomy and adenoidectomy in children,with a low incidence of adverse reactions.
万方数据
维普
