纳布啡在小儿日间手术疼痛护理中的作用[摘要]目的探?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3ug/kg，纳布啡组给予纳布啡0.3mg/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3h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1h（T1）、拔除喉罩后2h（T2）及拔除喉罩后3h（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[]R473.6[文献标识码]A[]1674-4721（2017）11（b）-0112-03[Abstract]ObjectiveToexploretheeffectofNalbuphineinpediatricdaytimeoperationpaininnursing.Methods136casesofthechildrenwithunilateralherniasachighligationundergeneralanesthesiaindaytimeoperatingroomofGuangzhouWomenandChildren′sMedicalCenterfromMarchtoDecemberin2016wereselectedandrandomlydividedintotheSufentanilgroup（69cases）andtheNalbuphinegroup（67cases）.PatientsoftheSufentanilgroupweregiven3ug/kgofSufentanil，whilepatientsoftheNalbuphinegroupweregiven0.3mg/kgofNalbuphinefortheinductionofgeneralanesthesia，andthepatientsweregivenplacementoflaryngealmask.Afteroperation，patientsweretransportedtothePACUwithlaryngealmask.Afterremovaloflaryngealmask，thepatientswereobservedfor3haccompaniedbyparents.FLACCpediatricpainscaleandRamsaysedationscalewereadoptedtorecordthechildren′ssedationandanalgesiaconditionsimmediatelyaftertheremovaloflaryngealmask（T0），1hafterremovaloflaryngealmask（T1），2hafterremovaloflaryngealmask（T2）and3hafterremovaloflaryngealmask（T3）.Theoccurrenceofadversereactionsduringtherecoveryperiodwasrecorded.ResultsThechildrenpainscoresoftheNalbuphinegroupatT0werehigherthanthatoftheSufentanilgroup，withsignificantdifference（P<0.05）.WhilethesedationscoresoftheNalbuphinegroupatT0，T1andT2werelowerthanthatoftheSufentanilgroup，withsignificantdifference（P<0.05）paredwiththeSufentanilgroup，theincidenceofhypoxemia，nauseaandvomitingduringtherecoveryperiodwasobviouslydecreasedintheNalbuphinegroup，withsignificantdifference（P<0.05），whiletherewasnostatisticallysignificantdifferenceintheincidenceofotheradverseeffects（P>0.05）.ConclusionNalbuphinecanproducelongeranalgesicdurationthanSufentanil，andcaneffectivelyreducetheincidenceofagitationandpostoperativeadversereactionduringtherecoveryperiod，whichisappropriateforpostoperativepainmanagementofchildrendaytimeoperation.[Keywords]Daytimeoperation；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...