摘要
目的：研究镇痛对体外循环下婴幼儿先天性心脏病矫治术后血糖及胰岛素水平的影响。方法：选择40例择期行先天性心脏病矫治术患儿随机分为镇痛组和对照组各20例。镇痛组用芬太尼0．5～2μg／（kg．h）持续静脉微量泵注入；对照组给予布洛芬5～8mg／kg／次。两组均用咪唑安定0．01～0．2mg／kg／h静脉持续微量泵注入或0．05～0．1mg／kg／次每2～4h间断静脉推注镇静。观察术后2h、8h、24h、48h的镇静、镇痛效果同时检测血糖和胰岛素的水平；观察恶心、呕吐、心率及血压下降、呼吸抑制等的副反应情况。结果：两组在术后2、8、24hComfort评分差异显著（P〈0．05），48hComfort评分两组无显著差异（P〉0．05）。镇痛组和对照组术后2、8、24、48h血糖和24、48h胰岛素与术前比较均升高且差异显著（P〈0．05）。镇痛组术后8、24、48h血糖与对照组相应时点的指标比较差异显著（P〈0．05）。镇痛组和对照组胰岛索水平各时点比较无差异（P〉0．05）。结论：婴幼儿心内直视术后存在血糖及胰岛素的剧烈变化的应激反应。术后镇痛可在一定程度上减轻术后的应激反应，而且不良反应较小。
Objective： To investigate the sedation and analgesia effects on bood glucose and insulin level of post - cardiac surgery in infants. Methods：forty patients with congenital heart disease were randomly divided into two groups after cardiac surgery. Analgesia group ：0. 5 -2μg/（ kg·h） Fentanyl continuous intravenous infusion was used in 20 patients undergoing cardiovascular surgery. 20 pa- tients were involved in the control group：5-8mg/kg/dose Ilprof was given by oral or nasalgastric tube. 0. 01 -0. 2mg,/kg/h midazolam continuous intravenous infusion or 0. 05 -0.1mg/kg/dose intermittent intravenous push were used in two groups for sedation. The effects and adverse effects of the sedation and analgesia were observed on 2 h,8 h,24 h,48 h after surgery of each group. The level of blood glucose and insulin were measured respectively. Results ：There was significant difference in Comfort value on 2 h,8 h ,24h （P 〈 0. 05） ,and no differentee on 48h between the two groups. Among the two groups,the level of blood glucose on 2 h,8 b,24 h,48 h and insulin on 24h,48h of pre - operation were significantly higher than those of post - operation（P〈0.05）. There was significant differ- ence in blood glucose at 8 h,24h and 48h of post operation between the two groups（ P 〈 0. 05 ）. No difference showed on insulin level between two groups（ P 〉 0.05 ）. Conclusion：There exists stress response inchuding the change of blood glucose and insulin level in post - cardic surgery infants. The sedation and analgesia of midazolam and Fentanyl can reduce stress reaction with less side - effects in infants after cardiac surgery.
出处
《牡丹江医学院学报》
2009年第3期18-20,共3页
Journal of Mudanjiang Medical University
基金
广东省科技厅资助项目(2006B36030007)
作者简介
张剑珲（1970-），女，医学硕士，副主任医师，从事儿科危重病研究工作。
