目的 探究亚剂量瑞芬太尼、常规全身麻醉在小儿上肢骨折中的应用价值及对患儿应激损伤的影响。方法 选取济南市儿童医院2023年10月至2024年10月上肢骨折患儿78例,随机数字表法将其分为对照组、观察组,各39例,对照组实施常规全身麻醉,观察组实施亚剂量瑞芬太尼麻醉,对比两组患儿临床各项指标情况。结果 术后,观察组感觉神经、运动神经阻滞时间增加,镇痛起效时间、苏醒时间减少（P<0.05）;观察组IL-13水平、Ramsay镇静评分高于对照组（P<0.05）;观察组生理应激指标水平、血流动力学指标水平、TNF-α、CRP、IL-1β水平、BPS镇痛评分、不良反应发生率低于对照组（P<0.05）。结论 相较于常规全身麻醉,为上肢骨折患儿实施亚剂量瑞芬太尼麻醉,不仅能显著缩短患儿的术后苏醒时间,还能大幅提升其镇痛与镇静效果;并且该麻醉方式有助于减轻患儿的机体炎症反应,有效改善生理应激损伤状况,且亚剂量瑞芬太尼麻醉还具有较高的安全性。
Abstract
Objective Exploring the application value of low-dose remifentanil and conventional general anesthesia in pediatric upper limb fractures and their impact on stress injury in children. Methods A total of 78 children with upper limb fractures were selected from Jinan Children's Hospital from October 2023 to October 2024. They were randomly divided into a control group and an observation group, with 39 cases in each group. The control group received routine general anesthesia, while the observation group received low-dose remifentanil anesthesia. The clinical indicators of the two groups of children were compared. Results After operation, sensory nerve and motor nerve block time increased, analgesic onset time and recovery time decreased in observation group (P<0.05). IL-13 level and Ramsay sedation score in observation group were higher than those in control group (P<0.05). The levels of physiological stress index, hemodynamic index, TNF-α, CRP, IL-1β, BPS analgesia score and incidence of adverse reactions in observation group were lower than those in control group (P<0.05). Conclusions Compared to conventional general anesthesia, administering low-dose remifentanil anesthesia to children with upper limb fractures can not only significantly shorten their postoperative recovery time, but also greatly improve their analgesic and sedative effects; And this anesthesia method helps to alleviate the inflammatory response of the child's body, effectively improve physiological stress damage, and sub dose remifentanil anesthesia also has high safety
关键词
亚剂量瑞芬太尼 /
常规全身麻醉 /
小儿上肢骨折 /
应激损伤
Key words
Subdose remifentanil /
Conventional general anesthesia /
Upper limb fractures in children /
Stress injury
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