刘佩珍

[摘要]目的 探討纳布啡在小儿日间手术疼痛护理中的作用。方法 选择2016年3～12月在广州市妇女儿童医疗中心日间手术室全身麻醉下行单侧疝囊高位结扎手术的136例患儿作为研究对象，随机分为舒芬太尼组（69例）和纳布啡组（67例）。舒芬太尼组给予舒芬太尼3 ug/kg，纳布啡组给予纳布啡0.3 mg/kg，进行全身麻醉诱导并置入喉罩，手术结束后带喉罩转运至PACU，待患儿拔除喉罩在患儿家长陪同下进行3 h的术后观察。采用FLACC小儿疼痛评分法和Ramsay镇静评分法，分别于拔除喉罩即刻（T0）、拔除喉罩后1 h（T1）、拔除喉罩后2 h（T2）及拔除喉罩后3 h（T3）4个时间点对两组患儿的镇痛及镇静情况进行记录，同时记录苏醒期内不良反应的发生情况。结果 纳布啡组患儿T0时的疼痛评分高于舒芬太尼组，差异有统计学意义（P<0.05）。纳布啡组患儿T0、T1和T2时点的镇静评分低于于舒芬太尼组，差异有统计学意义（P<0.05）。与舒芬太尼组相比，纳布啡组患儿苏醒期的低氧血症及恶心呕吐发生率明显降低，差异有统计学意义（P<0.05），其他不良反应发生率比较，差异无统计学意义（P>0.05）。结论 纳布啡可产生较舒芬太尼更长的镇痛时程，同时亦可有效减少患儿苏醒期躁动及术后不良反应的发生，适用于小儿日间手术术后的疼痛护理。

[关键词]日间手术；小儿；镇痛；纳布啡；疼痛护理

[中图分类号] R473.6 [文献标识码] A [文章编号] 1674-4721（2017）11（b）-0112-03

[Abstract]Objective To explore the effect of Nalbuphine in pediatric daytime operation pain in nursing.Methods 136 cases of the children with unilateral hernia sac high ligation under general anesthesia in daytime operating room of Guangzhou Women and Children′s Medical Center from March to December in 2016 were selected and randomly divided into the Sufentanil group （69 cases） and the Nalbuphine group （67 cases）.Patients of the Sufentanil group were given 3 ug/kg of Sufentanil，while patients of the Nalbuphine group were given 0.3 mg/kg of Nalbuphine for the induction of general anesthesia，and the patients were given placement of laryngeal mask.After operation，patients were transported to the PACU with laryngeal mask.After removal of laryngeal mask，the patients were observed for 3 h accompanied by parents.FLACC pediatric pain scale and Ramsay sedation scale were adopted to record the children′s sedation and analgesia conditions immediately after the removal of laryngeal mask （T0），1 h after removal of laryngeal mask （T1），2 h after removal of laryngeal mask （T2） and 3 h after removal of laryngeal mask （T3）.The occurrence of adverse reactions during the recovery period was recorded.Results The children pain scores of the Nalbuphine group at T0 were higher than that of the Sufentanil group，with significant difference （P<0.05）.While the sedation scores of the Nalbuphine group at T0，T1 and T2 were lower than that of the Sufentanil group，with significant difference （P<0.05）.Compared with the Sufentanil group，the incidence of hypoxemia，nausea and vomiting during the recovery period was obviously decreased in the Nalbuphine group，with significant difference （P<0.05），while there was no statistically significant difference in the incidence of other adverse effects （P>0.05）.Conclusion Nalbuphine can produce longer analgesic duration than Sufentanil，and can effectively reduce the incidence of agitation and postoperative adverse reaction during the recovery period，which is appropriate for postoperative pain management of children daytime operation.endprint

[Key words]Daytime operation；Children；Analgesia；Nalbuphine；Sufentanil

日间手术是指需要住院手术的患者于当日来院实施手术后，经短暂观察恢复后出院而无需过夜[1]，小儿日间手术室不仅降低医疗费用，还缩短患儿住院等待时间。但由于小儿患儿生理上的特殊性，术后行之有效的疼痛护理成为小儿日间手术后安全管理的关键问题。传统阿片镇痛药的呼吸抑制、呕吐等副作用[2]将大大限制其在小儿日间手术疼痛护理中的应用。……