氟比洛芬酯超前镇痛复合不同剂量的舒芬太尼对小儿骨盆截骨矫形术术后镇痛效果的比较

摘要

目的：
　　比较氟比洛芬酯超前镇痛复合不同剂量舒芬太尼对小儿骨盆截骨矫形术术后镇痛的效果，寻找适合小儿的术后镇痛模式。
　　方法:选取我院小儿骨科3～10岁的先天性髋脱位，拟于全麻下行骨盆截骨矫形术患儿90例，根据氟比洛芬酯复合舒芬太尼剂量的不同，将患儿随机分为N1、N2、N3三组。三组PCA舒芬太尼的剂量分别为1.5、2.0或2.5μg/kg，三组切皮前均给予静脉注射氟比洛芬酯1mg/kg超前镇痛。PCA泵中昂丹司琼含量均为0.1mg/kg，容量加生理盐水至100毫升。记录各组患儿在恢复室的气管插管拔除时间，患儿术后2、4、8、12、24、48h各个时间点的FLACC疼痛评分，术后48h内PCA按压次数、Ramsay镇静评分，恶心、呕吐、呼吸抑制等不良反应等。
　　结果三组患儿在恢复室的术后拔管时间差异无统计学意义（P＞0.05）。FLACC评分比较，术后4，8和12h，N2组、N3组明显低于N1组，差异有统计学意义(P＜0.05)，N3组低于N2组，差异有统计学意义(P＜0.05);术后24和48h，N3组低于N1组差异有统计学意义(P＜0.05)。术后48h PCA泵按压次数，N1组13次，N2组7次，N3组3次，差异有统计学意义(P＜0.05)。Ramsay评分比较，术后4，8和12h，N2组和N3组明显高于于N1组，差异有统计学意义(P＜0.05)，术后24和48h，N3组高于N1组差异有统计学意义(P＜0.05)。术后48h恶心，呕吐发生率N3组（8例）明显高于N1组（0例）和N2组（3例），差异有统计学意义(P＜0.05)。
　　结论氟比洛芬酯1mg/kg超前镇痛复合舒芬太尼2μg/kg是一种理想的小儿骨盆截骨矫形术的PCA模式。

目录

声明

INDEX

SYNOPSIS

摘要

ABSTRACT

ABREVIATIONS AND ACRONYMS INDEX

INTRODUCTION

1．1．1 BACKGROUND

1．1．2 General Considerations of Anesthesia

1．2 Physiology of pain

1．2．1 Transduction (Noxious Stimuli Translated Into Electrical Activities at the Sensory Nerve Endings)

1．2．3 Modulation (Release of Chemical Messengers From Higher Centerand Brain Stem That Modulates the Painful Stimuli)

1．3 Patient Controlled Analgesia (PCA)

1．4 Definition and Constitution of Multimodal Pain (MMP) Control

LITERATURE REVIEW

1．5 Anatomy

1．5．1 Posterior pelvic ligaments

1．5．2 Blood supply

1．6．1 Minimum requirements for general anesthesia

1．6．2 Preparing the patient

1．7 The Process of Anesthesia

1．7．1 Premedication

1．7．2 Induction

1．7．3 Maintenance phase

1．7．4 Positioning

1．7．5 Positioning for induction of general anesthesia

1．7．6 Positioning during general anesthesia

1．7．7 Recovery from General Anesthesia

1．8．1 Blood pressure

1．8．2 Electrocardiograph

1．8．3 Respiratory monitoring

1．8．4 Depth of anaesthesia monitoring

MATERIALS AND METHOD

2．1．1 Patient population and data collection

2．1．3 Methods

2．1．4 Statistical Methods

2．2．1 Pain Assessment

2．2．2 Chronieity of Pain

2．2．3 Severity of Pain

2．2．4 Quality of Pain

2．2．5 Anatomical Etiology of Pain

2．2．6 Mechanism of Injury

2．2．7 Barriers to Pain Assessment

RESULTS

3．1．1 Extubation time

3．1．2 FLACC score

3．1．3 PCA pump pressing times

3．1．4 Ramsay sedation score

3．1．5 Postoperative 48h adverse reactions

3．2．1 FLACC

DISCUSSION

4．1 Pharmacology

4．1．1 SUFENTANIL

4．1．2 Flurbiprofen axetil

4．2 Types of pelvic osteotomies

4．2．1 Selection of pelvic osteotomy procedure

4．2．2 Reshaping Osteotomies

4．2．3 Pemberton (pericapsular) osteotomy

4．2．4 Dega osteotomy

4．2．5 Single innominate osteotomy (Salter)

4．2．6 Double innominate osteotomy

4．2．7 Triple innominate osteotomy

CONCLUSION

ACKNOWLEDGEMENT

REFERENCE