瑞芬太尼与芬太尼对小儿斜视纠正术术后恶心呕吐和疼痛的影响的对比研究(2)
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本研究中,瑞芬太尼组术后呕吐发生率明显减少。虽然两组小儿术后25 h内呕吐例数接近,但瑞芬太尼组患儿呕吐次数较芬太尼明显减少(20:47)。本研究中未涉及出院时间或收入院例数等相关临床指标,因为所有患儿离开复苏室后均留院观察至少24 h。
有趣的是两组患儿夜间几乎均无呕吐发生。可能是因为睡眠中,没有一些增加呕吐发生的因素如体动引起的前庭刺激、疼痛、进食等。而且斜视术后引起呕吐的一大原因是视轴的变化,而睡眠中这一因素也不存在。本研究显示了一种术后呕吐发生的昼夜节律,夜间几乎没有呕吐发生。
拔管后即时瑞芬太尼组疼痛评分较高,但是30 min后两组患儿疼痛评分无统计学差异,因为当患儿疼痛评分较高时,则给予爱尔卡因滴眼。
综上所述,R组患者较F组患者术后呕吐发生率明显减少,但术后30 min内疼痛较明显。如果采用疼痛的补救药物,术后30 min后疼痛明显减轻。瑞芬太尼麻醉是一种较适合用于小儿眼科的阿片类药物。
参 考 文 献
[1] Schlager A, Mitterschiffthaler G, Puhringer F. Rectally administered dimenhydrinate redrces postoperative vomiting in children after strabismus surgery. Br J Anaesth, 2000,84:405406.
[2] Gan T, Sloan F, Dear GD, et al. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg,2001,92: 393400.
[3] Anderson BJ, Ralph Cj, Stewart AW, et al. The doseeffect relationship for morphine and vomiting after daystay tonsillectomy in children. Anaesth Intensive Care,2000,28:155160.
[4] Munro HM, Riegger LQ, Reynolds PI, et al. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth,1994,72: 624628.
[5] Song D, Whitten CW, White PF. Use of remifentanil during anesthetic induction: a comparison with fentanyl in the ambulatory setting. Anesth Analg,1999,88:734736.
[6] Guy J, Hindman BJ, Baker KZ, et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial spaceoccupying lesions. Anesthesiology,1997,86:514524.
[7] Rusch D, happe W, Wulf H. Postoperative nausea and vomiting following strabismus surgery in children: inhalation anesthesia with sevofluranenitrous oxide in comparison with intravenous anesthesia with propofolremifentanil. Anaesthesist,1999,48: 8088.
[8] Davis PJ, Lerman J, Suresh S, et al. A randomized multicenter study of remifentanil compared with alfentanil, isoflurane , or propofol in anesthetized pediatric patients undergoing elective strabismus surgery. Anesth Analg,1997,84: 982989.
[9] Pinsker MC, Carroll NV. Quality of emergence from anesthesia and incidence of vomiting with remifentanil in a pediatric population. Anesth Analg,1999,89:7174.
[10] Mendel HG, Guarnieri KM, Sundt LM, et al. The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. Anesth Analg,1995,80:11291133.
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