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目的探讨新生儿术后镇痛对感染发生率的影响。方法 120例行开腹手术新生儿随机均分为三组:A组术后输注芬太尼6-8μg/kg+0.9%氯化钠45ml;B组舒芬太尼0.6-0.8μg/kg+0.9%氯化钠45ml;C组给予0.9%氯化钠45ml。持续输注24h。记录术后新生儿疼痛评分(NIPS)。检测术前及术后24h时外周静脉血白细胞(WBC)计数、血清C-反应蛋白(CRP)及白细胞介素6(IL-6)含量;比较术后感染发生率。结果 A、B组术后镇痛效果均满意。术后感染发生率低于C组[15.0%、5.0%vs.35.0%],抗生素使用时间短于C组[(10.68±1.13)d、(7.22±0.46)d vs.(13.87±3.79)d](P<0.05)。术后,A、B组WBC计数低于C组[(10.93±5.08)×109/L、(8.83±2.98)×109/L vs.(13.97±5.96)×109/L],血清CRP低于C组[(38.52±20.31)mg/L、(27.67±16.50)mg/L vs.(67.44±24.82)mg/L],IL-6低于C组[(198.46±35.16)pg/ml、(156.94±15.08)pg/ml vs.(379.47±54.35)pg/ml],B组WBC计数、血清CRP和IL-6表达明显低于A组,抗菌药物使用时间亦短于A组(P<0.05)。结论新生儿术后用芬太尼和舒芬太尼,尤其是舒芬太尼镇痛,可减轻炎症反应和感染发生率。
Objective To investigate the effect of postoperative analgesia on the incidence of infection in neonates. Methods A total of 120 neonates undergoing laparotomy were randomly divided into three groups: group A received fentanyl 6-8μg / kg + 0.9% sodium chloride 45ml after operation; group B sufentanil 0.6-0.8μg / kg + 0.9% sodium chloride 45ml; Group C was given 0.9% sodium chloride 45ml. Continuous infusion 24h. Postoperative neonatal pain scores (NIPS) were recorded. Peripheral venous WBC counts, serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured before and 24 hours after operation. The incidence of postoperative infection was compared. Results A, B group postoperative analgesic effect are satisfied. The incidence of postoperative infection was lower than that of group C [15.0%, 5.0% vs.35.0%], antibiotic use time was shorter than that of group C [(10.68 ± 1.13) d, (7.22 ± 0.46) d vs. (13.87 ± 3.79) d ] (P <0.05). After operation, the WBC counts in group A and B were lower than those in group C [(10.93 ± 5.08) × 109 / L, (8.83 ± 2.98) × 109 / L vs. (13.97 ± 5.96) × 109 / L] The level of IL-6 in group C was significantly lower than that in group C [(38.52 ± 20.31) mg / L, (27.67 ± 16.50) mg / L vs. (67.44 ± 24.82) mg / 156.94 ± 15.08) pg / ml vs. (379.47 ± 54.35) pg / ml]. The counts of WBC, serum CRP and IL-6 in group B were significantly lower than those in group A ). Conclusion Neonatal postoperative analgesia with fentanyl and sufentanil, especially sufentanil, can reduce the incidence of inflammatory reactions and infections.