舒芬太尼与芬太尼用于危重症儿童镇痛、镇静的效果比较
|
摘要
目的:比较舒芬太尼与芬太尼用于危重症儿童镇痛、镇静的疗效,为临床用药提供参考。方法:回顾性选取2018年1—6月惠州市妇幼保健计划生育服务中心儿童重症监护病房使用芬太尼的患儿101例作为对照组,2018年7—12月使用舒芬太尼的患儿99例作为观察组。观察两组患儿镇痛前后的生命体征、肝功能指标水平、肾功能指标水平及血气分析指标水平,并比较两组患儿镇痛效果和不良反应发生情况的差异。结果:镇痛后,两组患儿心率、呼吸频率、平均动脉压及脉搏血氧饱和度的差异均无统计学意义(P>0.05);两组患儿天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素、白蛋白及总蛋白水平的差异均无统计学意义(P>0.05);两组患儿肌酐、尿素氮水平的差异均无统计学意义(P>0.05);两组患儿动脉血二氧化碳分压、动脉血氧分压水平的差异均无统计学意义(P>0.05)。给药第3日,观察组、对照组患儿的镇痛达标率分别为47.5%(47/99)、48.5%(49/101),镇静达标率分别为20.2%(20/99)、18.8%(19/101),差异均无统计学意义(P>0.05)。观察组、对照组患儿的不良反应发生率分别为13.1%(13/99)、14.9%(15/101),差异无统计学意义(P>0.05);但观察组患儿的低血压发生率为1.0%(1/99),明显低于对照组的5.0%(5/101),差异有统计学意义(P<0.05)。结论:舒芬太尼与芬太尼用于危重症儿童的镇痛效果相近,但应用舒芬太尼的患儿低血压发生率较低。
OBJECTIVE: To compare the analgesic and sedative effects between sufentanil and fentanyl in critically ill children, so as to provide references for clinical use of drugs. METHODS: 101 children with application of fentanyl admitted into PICU in Huizhou Maternal and Child Health Family Planning Service Center in Jan.-Jun. 2018 were retrospectively selected as the control group, another 99 children with application of sufentanil in Jul.-Dec. 2018. The vital signs, indices of liver function, renal function and blood gas analysis of the two groups before and after analgesia were observed, differences in analgesic effect and incidence of adverse drug reactions between two groups were compared. RESULTS: After analgesia, there were no statistical significance in differences of heart rates, respiratory rates,mean arterial pressure and saturation of pulse oximetry between two groups(P>0.05); there were no statistical significance in differences of aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin and total protein levels between two groups(P>0.05); there were no statistical significance in differences of creatinine and urea nitrogen levels between two groups(P>0.05); there were no statistical significance in differences of partial pressure of carbon dioxide in artery and arterial partial pressure of oxygen levels between two groups(P>0.05). At the 3 rd day of administration, the control rates of analgesia of observation group and control group were respectively 47.5%(47/99) and 48.5%(49/101), the control rates of sedation of observation group and control group were respectively 20.2%(20/99) and 18.8%(19/101), the differences had no statistical significance(P>0.05). The incidences of adverse drug reactions of observation group and control group were respectively 13.1%(13/99) and 14.9%(15/101), the difference had no statistical significance(P>0.05); while the incidence of hypotension of observation group was 1.0%(1/99), which was significantly lower than that of the control group(5.0%, 5/101), with statistically significant difference(P<0.05). CONCLUSIONS: Sufentanil has similar analgesic and sedative effects with fentanyl in critically ill children, while the incidence of hypotension is lower in children with application of sufentanil.
OBJECTIVE: To compare the analgesic and sedative effects between sufentanil and fentanyl in critically ill children, so as to provide references for clinical use of drugs. METHODS: 101 children with application of fentanyl admitted into PICU in Huizhou Maternal and Child Health Family Planning Service Center in Jan.-Jun. 2018 were retrospectively selected as the control group, another 99 children with application of sufentanil in Jul.-Dec. 2018. The vital signs, indices of liver function, renal function and blood gas analysis of the two groups before and after analgesia were observed, differences in analgesic effect and incidence of adverse drug reactions between two groups were compared. RESULTS: After analgesia, there were no statistical significance in differences of heart rates, respiratory rates,mean arterial pressure and saturation of pulse oximetry between two groups(P>0.05); there were no statistical significance in differences of aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin and total protein levels between two groups(P>0.05); there were no statistical significance in differences of creatinine and urea nitrogen levels between two groups(P>0.05); there were no statistical significance in differences of partial pressure of carbon dioxide in artery and arterial partial pressure of oxygen levels between two groups(P>0.05). At the 3 rd day of administration, the control rates of analgesia of observation group and control group were respectively 47.5%(47/99) and 48.5%(49/101), the control rates of sedation of observation group and control group were respectively 20.2%(20/99) and 18.8%(19/101), the differences had no statistical significance(P>0.05). The incidences of adverse drug reactions of observation group and control group were respectively 13.1%(13/99) and 14.9%(15/101), the difference had no statistical significance(P>0.05); while the incidence of hypotension of observation group was 1.0%(1/99), which was significantly lower than that of the control group(5.0%, 5/101), with statistically significant difference(P<0.05). CONCLUSIONS: Sufentanil has similar analgesic and sedative effects with fentanyl in critically ill children, while the incidence of hypotension is lower in children with application of sufentanil.
引文
[1] 刘鲲鹏,廖旭,薛富善.舒芬太尼的药理学和临床应用[J].中国医药导刊,2005,7(6):454-457.
[2] 吴洁.舒芬太尼在心脏手术麻醉中应用的研究进展[J].医学综述,2013,19(8):1469-1472.
[3] 朱云峰,彭丽,幸吉娟,等.三种剂量舒芬太尼用于患儿腹腔镜手术的麻醉效果[J].临床麻醉学杂志,2012,28(9):878-881.
[4] 李金凤,高昭,王建民,等.不同剂量舒芬太尼对大鼠麻醉及恢复的影响[J].南京理工大学学报:自然科学版,2013,37(3):453-456.
[5] 王荃,钱素云.危重儿童常用镇静镇痛评估方法[J].中国小儿急救医学,2014,21(2):80.
[6] 中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科学组,中国医师协会重症医学医师分会儿科专业委员会.儿童重症监护治疗病房镇痛和镇静治疗专家共识(2013版)[J].中华儿科杂志,2014,52(3):191.
[7] 童文佳,宋从磊,金丹群,等.不同镇静方案对多发伤重症儿童的镇静效果及对炎症反应的影响[J].中华危重病急救医学,2017,29(6):542-546.
[8] 钱素云.镇痛镇静治疗的发展历史与现状[J].中国小儿急救医学,2014,21(2):65-67.
[9] Playfor SD.Analgesia and sedation in critically ill children[J].Arch Dis Child Educ Pract Ed,2008,93:87-92.
[10] Lamas A,López-Herce J.Monitoring sedation in the critically ill child[J].Anaesthesia,2010,65(5):516-524.
[11] 喻文亮.PICU常用镇痛镇静药物特点及使用方法[J].中国小儿急救医学,2014,21(2):74-78,83.
[12] Chaveron D,Silva S,Sanchez-Verlaan P,et al.The 90% effective dose of a sufentanil bolus for the management of painful positioning in intubated patients in the ICU[J].Eur J Anaesthesiol,2012,29(6):280-285.
[13] Ebert TJ,Ficke DJ,Arain SR,el a1.Vasodilation from sufentanil in humans[J].Anesth Analg,2005,101(6):1677-1680.
[14] 丛露,王珊娟,杭燕南.芬太尼、舒芬太尼、瑞芬太尼对呼吸功能的影响[J].实用疼痛学杂志,2007,3(5):379-383.
[15] Bameshki AR,Zanjankhah MR,Gilani MT,et al.Intrathecal suf-entanil for intraoperative and postesophagectomy pain relief[J].South Med J,2010,103(3):197-201.
[16] Payen JF,Chanques G,Mantz J,et al.Current practices in sedation and analgesia for mechanically ventilated critically ill patients:apro-spective muhicenter patient-based study[J].Anesthesiology,2007,106(4):687-695.
[17] Sanatkar M,Sadeghi M,Esmaeili N,et al.The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in pati-ents with low myocardial ejection fraction[J].Acta Med Iran,2013,51(7):438-443.
[2] 吴洁.舒芬太尼在心脏手术麻醉中应用的研究进展[J].医学综述,2013,19(8):1469-1472.
[3] 朱云峰,彭丽,幸吉娟,等.三种剂量舒芬太尼用于患儿腹腔镜手术的麻醉效果[J].临床麻醉学杂志,2012,28(9):878-881.
[4] 李金凤,高昭,王建民,等.不同剂量舒芬太尼对大鼠麻醉及恢复的影响[J].南京理工大学学报:自然科学版,2013,37(3):453-456.
[5] 王荃,钱素云.危重儿童常用镇静镇痛评估方法[J].中国小儿急救医学,2014,21(2):80.
[6] 中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科学组,中国医师协会重症医学医师分会儿科专业委员会.儿童重症监护治疗病房镇痛和镇静治疗专家共识(2013版)[J].中华儿科杂志,2014,52(3):191.
[7] 童文佳,宋从磊,金丹群,等.不同镇静方案对多发伤重症儿童的镇静效果及对炎症反应的影响[J].中华危重病急救医学,2017,29(6):542-546.
[8] 钱素云.镇痛镇静治疗的发展历史与现状[J].中国小儿急救医学,2014,21(2):65-67.
[9] Playfor SD.Analgesia and sedation in critically ill children[J].Arch Dis Child Educ Pract Ed,2008,93:87-92.
[10] Lamas A,López-Herce J.Monitoring sedation in the critically ill child[J].Anaesthesia,2010,65(5):516-524.
[11] 喻文亮.PICU常用镇痛镇静药物特点及使用方法[J].中国小儿急救医学,2014,21(2):74-78,83.
[12] Chaveron D,Silva S,Sanchez-Verlaan P,et al.The 90% effective dose of a sufentanil bolus for the management of painful positioning in intubated patients in the ICU[J].Eur J Anaesthesiol,2012,29(6):280-285.
[13] Ebert TJ,Ficke DJ,Arain SR,el a1.Vasodilation from sufentanil in humans[J].Anesth Analg,2005,101(6):1677-1680.
[14] 丛露,王珊娟,杭燕南.芬太尼、舒芬太尼、瑞芬太尼对呼吸功能的影响[J].实用疼痛学杂志,2007,3(5):379-383.
[15] Bameshki AR,Zanjankhah MR,Gilani MT,et al.Intrathecal suf-entanil for intraoperative and postesophagectomy pain relief[J].South Med J,2010,103(3):197-201.
[16] Payen JF,Chanques G,Mantz J,et al.Current practices in sedation and analgesia for mechanically ventilated critically ill patients:apro-spective muhicenter patient-based study[J].Anesthesiology,2007,106(4):687-695.
[17] Sanatkar M,Sadeghi M,Esmaeili N,et al.The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in pati-ents with low myocardial ejection fraction[J].Acta Med Iran,2013,51(7):438-443.