| Objective:To study the effects of tramadol combined with tropisetron on sedation and analgesia and complications control after transcatheter closure in children with congenital heart disease.Methods:1.This study investigated 170 patients with congenital heart disease who were treated with concurrent interventional occlusion surgery.They were divided into experimental group and control group:(1)The experimental group included 85 children(42 with ventricular septal defect,21 with atrial septal defect,20 with patent ductus arteriosus and 2with pulmonary stenosis)who were diagnosed with congenital heart disease and underwent interventional therapy in the second department of pediatrics affiliated hospital of southwest medical university from January 2017 to June 2019.Among them,37 were male and 48 were female,Age 2.7(2.0,4.7)years old,weight 15.0(13.0,20.0)kg,operation time 50.0(40.0,65.0)min.(2)The control group included 85children(40 with ventricular septal defect,15 with atrial septal defect,28with patent ductus arteriosus,and 2 with pulmonary stenosis)who were diagnosed with congenital heart disease in the second department of pediatrics affiliated hospital of southwest medical university from June2015 to December 2016.There were 40 male and 45 female children,Age3.1(2.2,4.3)years old,weight 16.0(14.0,20.0)kg,operation time 48.0(40.0,60.0)min.There was no significant difference between the two groups in sex composition ratio(?~2=0.214,P>0.05),age(t=0.141,P>0.05),weight(t=1.526,P>0.05),operation time(t=1.372,P>0.05),operation method(Fisher accurate test,P>0.05).2.All the patients were completed preoperative examinations such as color Doppler echocardiography,electrocardiogram,chest radiograph,pulmonary function,biochemistry,blood routine,electrolyte,myocardial injury markers,pre transfusion examination,etc.When they were admitted to the hospital,they were diagnosed as children with simple congenital heart disease,were able to tolerate the interventional blocking operation,and communicated with their guardians to sign operation related documents and use postoperative analgesic drugs.All the patients were operated by the same surgeon.After the operation,the same nursing teacher who had received professional training was responsible for the treatment of wound compression and bandaging,and special personnel were assigned to carry out the postoperative FLACC pain score and observe the postoperative complications.3.The children in the experimental group were diluted with tramadol(1mg/kg)plus normal saline to 10ml after intervention and then slowly injected into the vein,At the same time,tropisetron(0.1mg/kg)was added to physiological saline and diluted to 10ml slowly after intravenous injection;In the control group,0.3%ropivacaine(3mg/kg)was injected into the puncture site by local infiltration.The administration time of the two groups was at the time of estuation,After pulling out the sheath,the puncture site was pressurized and bandaged immediately.The FLACC score,bleeding or hematoma at the puncture site,ecchymosis,device displacement or detachment,residual shunt volume,hypotension,nausea and vomiting and other complications were recorded within 24 hours.Results:1.FLACC pain score indicated that the incidence of moderate and severe pain in the experimental group was lower than that in the control group,while the incidence of painless and mild pain was higher than that in the control group,with statistically significant differences(Z=8.221,P<0.001).2.The incidence of ecchymosis in the experimental group was lower than that in the control group,the difference was statistically significant(?~2=6.538,P<0.05);the incidence of hematoma or hemorrhage,residual micro shunt and arrhythmia in the experimental group was lower than that in the control group,the difference was not statistically significant(P>0.05).3.There were no complications such as blockage device displacement or detachment,hypotension,nausea and vomiting,and pericardial tamponade in both the experimental group and the control group.3.There was a positive correlation between the degree of pain and postoperative complications(P<0.05).Conclusion:1.After the intervention of congenital heart disease in children,the use of tramadol combined with tropisetron is effective for sedation and analgesia.2.The use of tramadol combined with tropisetron in children with congenital heart disease intervention is beneficial to the control of postoperative complications than ropivacaine.3.There is a positive correlation between the degree of pain and postoperative complications in children with congenital heart disease. |
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