| Background and ObjectivePostoperative analgesia can cause severe stress reactions which are unbenefit to recovery and postoperative analgesia is important to ensure the success of operation and safe recovery of patients. But there are some reasons which slow down the development of infantile postoperative analgesia:considering that infants cannot feel pain or suffer pain much lighter than adults;lack of routine evaluation ;lack of the latest knowledge of analgesia method and correct dose so they worry about the breath restrain and other side effect which causes by the drugs;considering the infantile analgesia could take too much time and energy. Aiming at this actuality the research was made to approach the feasibility of postoperative analgesia of buprenorphine and sulfentanil for infant of congenital heart disease.Materials and Methods45 aged 1-3 years with ventricular or(and) atrial septal defect and heart function I - II grade patients were choosed. The ratios of heart and breast were 0.55-0.60 and pulmonary general circulation were less than 2 .The patients were divided into 3 groups: control group C,used normal sodium; the group B used Buprenorphine,the group S used sulfentanyl. Before anesthetization,drawn the venous blood 2ml (To), and centrifuged 10 minutes in the speed of 3500r/min after been stored 30 minutes in room temperature,then took the blood serum 0.5ml and put into -70°C refrigerator after numbered to determine the concentration of cortisol in blood serum.The same group doctors finished anesthetization,operation and cardiopulmonary bypass. Recorded the time of CPB and operation.After operation,in group C ,normal sodium was injected with the speed 2-3ml/h in vein by microinfusion pump. In group B,analgesia was maintained with bolus infusion of buprenorphine 2ug/kg and continuous infusion 0.5μg·kg-1·h-1 .In group S, analgesia was maintained with bolus infusion of sufentanil 0.2μg/kg and continuous infusion 0.05μg·kg-1·h-1In ICU, GE-Dash4000 monitor and respiration machine were used for infant.Any fidgeting child was injected midrazolam 0.1mg/kg i.v. Observed the time of extubation ,the conditions of nausea and vomiting and times to use midrazolam. Afer operation in 8 hours( T1), 14 hours(T2),24 hours (T3),32 hours(T4).recorded heart rate(HR),mean arterial pressure(MAP) and partial pressure of carbon dioxide(PaCO2 ),and the score of FLACC.Detected the concentration of cortisol at the time of postoperation (To) 8 hour(T1),14 hour(T2),24 hour (T3)and 32 hour (T4)after operation by using radioimmunoassay(RIA).Statistial analysis: The statistical software package SPSS 10.0 was used, chi-square test was used test for numeration data and one-sample T-test,one-way ANOVA for measurement data . A P values less than 0.05 was considered statistically significant.Results1 .The difference of age,weight,the time of operation and CPB of three group patients was not statistically significant(P> 0.05).2.The time of extubation of three group patients was not statistically significant(P> 0.05).3.The difference of PaCO2 of three group patients was not statistically significant(P> 0.05).4.The score of FLACC of the three group at T1,T2,T3 was statistically significant(P< 0.05). At T4, it was not statistically significant(P> 0.05)5.The HR and the MAP of the three group at T1,T2,T3 was statistically significant(P< 0.05). At T4 .there were not statistically significant(P> 0.05)6. The comparison of Cor concentrations in serum:①Within group: The difference of Cor of the five points in the C group was not statistically significant(P > 0.05).The Cor of the four points in the B group and S group was less than T0 ,and was statistically significant(P< 0.05). The difference of Cor of the points of T1,T2,T3,T4 was not statistically significant(P> 0.05).②Between group:The difference of the Cor of the points T0 of the three groups was not statistically significant(P> 0.05). The difference of Cor of the points of T1,T2,T3,T4 Of the three groups was statistically significant(P< 0.05),and groupC > groupB > groups.③The Cor of the three group at T2 was highter than ceiling value of the physiological standard (μ=5.98ug/dl), and was statistically significant(P < 0.05).7.Compared the frequency of fidget among three groups: groupC > groupB > groupS(P < 0.05). That meant that sulfentanyl had a lower incidence of fidget than buprenorphine.8.Side effect PONV of three groups was not statistically significant(P > 0.05).conclusion1 .Postoperative analgesia of buprenorphine or sulfentanil for infant of congenital heart disease is feasible,and the analgesic effect of the latter is better,but the side effect is less.2.Severe stress state remains in the earlier stage after surgery of the infantile congenital heart disease, cortisol secretion loses normal rhythm in the severe stress. |
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