摘要
目的对比观察应用丙泊酚复合吗啡在婴幼儿心脏快通道麻醉术后镇静镇痛、抗呕吐及血流动力学的改变。方法60例,ASAⅠ～Ⅱ级,年龄5个月至3岁,体重5.5～14kg;择期在应用瑞芬太尼实施的快通道心脏麻醉心内直视手术的患者,随机分为单纯吗啡镇痛组(A组,30例)和丙泊酚复合吗啡镇痛组(B组,30例)。分别于术毕(T0)、拔管前1h(T1)、拔管即刻(T2)、术后12h(T3)、术后24h(T4)、术后48h(T5)记录心率(HR)、血压(MAP)、脉搏氧饱和度(SpO2)、呼吸频率(RR)、气道峰压(Ppeak)。采用数字评分方法(NRS)进行疼痛评分,并记录恶心呕吐及其它不良情况发生率。结果两组NRS评分有显著性差异(P<0.05),恶心呕吐发生率A组明显高于B组(P<0.05),B组血流动力学稳定明显优于A组。B组患者耐管良好,安静无烦躁,无意外拔管及动、静脉管脱出现象。A组术后1～2h60%患者出现烦躁,挣扎,自主呼吸与呼吸机对抗,使Ppeak升高,SpO2下降,有5例患者出现意外拔管,3例出现动脉测压管脱出。结论婴幼儿心脏快通道麻醉术后丙泊酚复合吗啡镇静镇痛、抗呕吐效果及维持血流动力学稳定明显优于单纯吗啡镇痛组。
Objective To observe the efficacy of propofol combined with morphine used for postoperative analgesia in children undergone fast track cardiac anesthesia procedure. Methods Sixty children and infants undergone open heart surgery under remifentanil-based fast track anesthesia were randomly divided to two groups, after operation who received analgesia treatment by morphine （group A） and propofol combined with morphine （group B）, At 0,12,24,48 hours after operation and pre-and postextubation relorded the change of HR,MAP, SpO2, RR, Ppeak and pain scores of NRS, incidence of adrerse reaction suchas naused and vomiting, Results The pain scores and incidence of nausen and vomiting in group A were higer than those in group B（P〈0.05）. The baemodynamics was more stable and intubation was well tolerated in group B. Concluison Propofol combined with morphine have well effect of postoperative analgesia and lower ratio of adverse reaction and more stable haemodynamics than those of alone morphine.
出处
《实用医药杂志》
2008年第11期1297-1299,共3页
Practical Journal of Medicine & Pharmacy
