| ObjectiveTo evaluate the efficacy and validity of fentanyl combined with tropical anesthesia in laser photocoagulation of retinopathy of prematurity(ROP).MethodsA cohort of 82 patients who were treated by ROP laser photocoagulation were randomly divided into the control group and the experimental group.The control group included 40 patients conducting tropical anesthesia.And the experimental group included 42 patients conducting fentanyl combined with tropical anesthesia. In the control group, proparacaine hydrochloride eye drops were given 5 min before treatment.And additional drop of proparacaine hydrochloride eye drops were given to each eye per 5~10 min. The experimental group was the same with the control group except additional fentanyl(3ug·kg-1·h-1) that was infused continuously through an pump during the treatment.All patients were intubated and ventilated in the experimental group during the treatment. Premature infant pain profile(PIPP) scores,Changes of heart rate(HR),mean artery pressure(MAP) and oxygen saturation(Sp O2)were recorded.And also the occurrence of complications within three days after operation was recorded.The level of epinephrine and norepinephrine,cortisol in the blood had been measured before and after the treatment. Data was analyzed using SPSS 18.0 statistical software.Results1.Comparison of PIPP scores of patients of the experimental group to patients of the control group during ROP laser photocoagulation There were 5patients(11.9%) in the experimental group and 28 patients(70.0%) in the control group whose maximum PIPP score were ≥ 6. The difference of the percentage of the maximum PIPP score were ≥6 between the two groups were statistically significant( P < 0.001). In the experimental group, the PIPP scores at the beginning of operation,the maximum PIPP scores during operation and the PIPP scores at the end of operation were 2.0(0-3.0), 3.0(2.0-3.0)and 1.5(0.8-2.0)respectively. In the control group, the PIPP scores at the beginning of operation,the maximum PIPP scores during operation and the PIPP scores at the end of operation were 8.0(4.0-10.0), 8.0( 5.0-11.0) and 8.0( 2.5-8.0) respectively.The difference of PIPP scores at the beginning of operation, the maximum PIPP scores during operation and the PIPP scores at the end of operation beween the two group were statistically significant(P<0.001).2. Changes of the serum level of stress related factors of patients in the experimental group and the control group after operation In the experimental group, the serum levels of epinephrine,norepinephrine and cortisol before operation were 46.4(36.7-106.2)pg/ml,144.1(80.5-271.1)pg/ml and 21.9(17.2-26.7)ng/ml,respectively.The serum level of epinephrine, norepinephrine and cortisol after operation were 47.4(37.0-106.6)pg/ml,155.0(87.2-239.7)pg/ml and 22.3(17.4-25.0)ng/ml,respectively.The difference of serum levels of epinephrine,norepinephrine and cortisol before and after operation were not statistically significant(P>0.05).In the control group,the serum level of epinephrine, norepinephrine and cortisol before operation were75.8(43.6-96.2)pg/ml, 160.7(113.3-230.2)pg/ml and 15.6(11.9-33.3)ng/ml, respectively.The serum level of epinephrine,norepinephrine and cortisol after operation were 83.8(59.0-148.6)pg/ml,194.4(136.2-322.0)pg/ml and29.0(18.9-39.6)ng/ml,respectively.The difference of the serum level of epinephrine,norepinephrine and cortisol before and after operation were statistically significant(P<0.001).3. Changes of physiological indexes of patients in the experimental group and the control group after operation In the experimental group,the HR level in the quiet condition before operation,at the end of operation and 1 hour after operation were(130.9±10.78)beats/minutes,(137.4±12.99)beats/minutes and(135.4±12.31)beats/minutes, respectively.The difference between the HR level in the quiet condition before operation and the HR level at the end of operation was statistically significant( P < 0.05). The difference between the HR level in the quiet condition before operation and the HR level at 1 hour after operation was not statistically significant(P>0.05).In the control group, the HR level in the quiet condition before the operation,at the end of the operation and 1 hour after the operation were(134.8±12.34)beats/minutes,(142.0±16.61)beats/minutes and(141.8±13.80)beats/minutes,repectively.Both the HR level at the end of operation and the HR level at 1 hour after operation had significant statistical difference with the HR level in the quiet condition before operation(P<0.05). In the experimental group, the MAP level in the quiet condition before operation,at the end of operation and 1 hour after operation were(42.4±2.60)mm Hg,(44.3±2.71)mm Hg and(42.7±2.35)mm Hg, respectively.Both the MAP level at the end of operation and 1 hour after operation had statistically significant difference with the MAP level in the quiet condition before operation(P<0.001;P<0.05). In the control group, the MAP level in the quiet condition before operation,at the end of operation and 1 hour after operation were(42.6±2.87)mm Hg,(44.5±3.07)mm Hg and(43.2±2.79)mm Hg, respectively. Both the MAP level at the end of operation and 1 hour after operation had statistically significant difference with the MAP level in the quiet condition before operation(P<0.001;P<0.05).4. Occurrence of postoperation complications of patients in the experimental group and the control group There were 24 patients suffered from different complications within three days after operation such as digestive tracthemorrhage,gastrointestinaldisorders, pneumonia, apnea, necrotizing enterocolitis and intracranial hemorrhage after operation, included 8 patients(19.0%) in the experiental group and16 patients(40.0%) in the control group. The difference of incidence between the two groups was statistically significant(P<0.05).ConclusionDuring ROP laser photocoagulation in neonate intensive care unit,the pain scores of patients under fentynal combined with tropical anesthesia were lower than those under tropical anesthesia.And the stress responses and complications after opertation in patients under fentynal combined with tropical anesthesia were also less than the patients under tropical anesthesia.The method of fentynal combined with tropical anesthesia is a safe and effective analgesic method which could be widely applied in clinical practice. |
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