氟比洛芬脂在小儿唇腭裂修复术后镇痛中的运用
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[摘要]目的：将氟比洛芬脂(凯芬)用于小儿唇腭裂修复术后镇痛，观察其效果及安全性。方法：40例唇腭裂患儿随机分两组：实验组(S组)和对照组(D组)，手术结束前10min S组静注氟比洛芬脂(1mg/kg)，D组静注0.9%生理盐水(0.1ml/kg)。记录各组患儿术毕后的CRIES评分。结果：术后8h内实验组(S组)CRIES评分明显低于对照组(D组)，两组间自主呼吸恢复，意识恢复和拔管时间比较差异无显著性(P>0.05)。均未见明显的不良反应。结论：氟比洛芬脂具有提高小儿围手术期安全性和舒适度，为小儿镇痛提供了新的选择。
[关键词]氟比洛芬脂；小儿；唇腭裂修复术；术后镇痛
[中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2011)07-1078-03
The use of flurbiprofen axetil on post-operative analgesia of pediatrics cleft lip and palate repairing operation
WANG Yong,LI Jian-hua
(Department of Anesthesia, PLA NO. 161 Hospital,Wuhan 430010,Hubei,China)
Abstract:ObjectiveAdopt flurbiprofen axetil in post-operative analgesia of pediatrics cleft lip and palate repairing operation, and observe its effect and security.Methods Put 40 cleft lip and palate children into two groups randomly: experimental group (Group S)and control group (Group D).Ten minutes before finishing the operation, use 1mg/kg flurbiprofen axetil in intravenous injection on Group S, while 0.1ml/kg normal saline on Group D. Record the children's post-operative CRIES scores.ResultsIn 8 hours after the operation,the CRIES scores of Group S are clearly much lower than those of Group D.Between these two groups, there is no great difference in their recovery of self-respiration,consciousness and extubation time.(P>0.05).No distinct adverse reaction appears in both of the two groups.ConclusionFlurbiprofen axetil is efficient in boosting security and comfort index in pediatric operation,thus it can serves as a new choice in pediatric analgesia.
Key words:flurbiprofen axetil;pediatrics;cleft lip and palate repairing operation;post-operative analgesia
小儿唇腭裂修复术后疼痛是一种不愉快的感觉和情绪体验，如果疼痛治疗不充分会带来日后痛觉异常。氟比洛芬脂(商品名凯纷)是一种利用药物靶向技术的通过抑制前列腺素合成，发挥靶向镇痛效果的非甾体抗炎药[1]。本研究观察了氟比洛芬脂在小儿唇腭裂修复术后镇痛的效果和安全性。
1资料和方法
1.1一般资料：40例择期行唇腭裂修复术患儿，ASA Ⅰ级，年龄3个月～7岁，体重4.5～22kg。唇裂修复术23例，腭裂修复术17例，随机将病例分为实验组(S组)和对照组(D组)，所有患儿无肝肾及血液系统功能障碍，无神经系统疾病，24h内未应用镇静药物。
1.2麻醉和镇痛方法：患儿术前肌注阿托品0.01mg/kg，均采用气管插管吸入全身麻醉。入室后七氟醚面罩吸入麻醉诱导，患儿入睡后开放静脉通路，静注芬太尼0.002mg/kg，维库溴铵0.1mg/kg，咪达唑仑0.1mg/kg，行气管插管，七氟醚2%～3%维持麻醉，氧流量1～2L/min；常规监测血压、脉搏、心电图、呼气末二氧化碳浓度和脉搏血氧饱和度，手术结束前10min S组静注氟比洛芬脂(1mg/kg)[2]，D组静注0.9%生理盐水(0.1ml/kg)，术毕停吸七氟醚，调高氧流量到5L/min，待患儿反射恢复，呼之可以睁眼后清理口咽分泌物，拔除气管导管，面罩给氧，观察患儿20min，生命体征平稳后送回病房，侧卧、吸氧，继续监测生命体征。疼痛强度评分：采用CRIES(Crying，Requires O2 saturation，Increased vital sings，Expression，Sleeplessness)评分表，通过哭泣、呼吸、循环、表情和睡眠进行评估，分数越高，疼痛越严重(见表1)。
1.3统计分析：计量资料数据均以x±s表示，计数资料间比较采用χ2检验；P<0 ......
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