摘要
目的:比较不同配方镇痛药用于鼻内窥镜手术后的患者自控镇痛效果。方法:纳入深圳市第二人民医院2003-10/2004-10耳鼻喉科住院患者40例,均在全麻下行鼻内窥镜手术,术后48h内患者自控静脉镇痛。病例随机分为实验组20例,芬太尼0.5mg,氯诺昔康32mg,溶于100mL生理盐水中;对照组20例,芬太尼1.4mg,溶于100mL生理盐水中。背景速度均为2mL/h,患者自控静脉镇痛1mL/次,锁定时间6min。术后48h内根据患者的休息时间及状况每8～14小时随诊1次,记录目测类比评分、用药量、患者自控静脉镇痛次数及术后镇静程度。患者术后疼痛评判采用目测类比评分法,0代表无痛,10代表剧痛。镇静程度分5级:Ⅰ=清醒;Ⅱ=瞌睡;Ⅲ=入睡,但可唤醒;Ⅳ=深睡,不能被语言唤醒,可被推醒;Ⅴ=任何方法无法唤醒。结果:按意向处理分析,40例患者均进入结果分析,实验组20例,对照组20例。①术后镇痛评分:两组术后48h内目测类比评分<4分。②术后镇痛药用量:对照组芬太尼用量多于实验组犤(1.32±0.06),(0.46±0.03)mg,P<0.05犦。③患者自控静脉镇痛有效按压次数:两组相似犤实验组为(44.57±4.01)次/48h,对照组(47.15±4.25)次/48h犦。④两组术后镇静程度:实验组与对照组相比差异有显著性犤实验组:Ⅰ级13例,Ⅱ级5例,Ⅲ级2例;对照组:Ⅰ级4例,Ⅱ级10例,Ⅲ级6例,P<0.05犦。⑤不良反应:在发生的比例上实验组明显少于对照组。结论:氯诺昔康可有效加强鼻内窥镜手术后芬太尼的镇痛作用,明显减少芬太尼用量及不良反应,提高镇痛的安全性及镇痛质量。
AIM： To compare the clinical effects of different formula analgesic used for patient-controlled analgesia after endoscopic sinus surgery （ESS）. METHODS： Totally 40 inpatient of Department of Otolaryngology, Shenzhen Second People＇s Hospital between October 2003 and October 2004 were involved. The endoscopic sinus surgery was conducted under total anesthesia, and within 48 hour after operation the vein analgesia was selfcontrolled of the patients. They were assigned randomly into experimental group with 20 cases, 0.5 mg fentanvl and 32 mg lornoxicam were dissolved in the 100 mL saline; control group with 20 cases, 1.4 mg fentanvl was dissolved in the 100 mL saline. The background speed was all 2 mL per hour. The patient-controlled analgesia was conducted 1 mL every time, and the fixed time was 6 minutes. In 48 hours after operation, every 8-14 hours the patients were followed up once according to the test time and status. The visual analogue score, amount of medication, number of times of the patient-controlled analgesia and the sedation degree post-operation were recorded. The visual analogue scale （VAS） was used to assess the ache after operation, 0 for no pain, 10 for severe pain. The level of sedation was divided into 5 grades： Ⅰ=clearmindedness, Ⅱ=drowsiness,Ⅲ=falling asleep, but could be awaken,Ⅳ=deep sleep,could not be awaken by lan-guage, but could be awaken by push,Ⅴ=could not be awaken by any way. RFSULTS：According to intention-to-treat analysis, 40 patients were all involved in the result analysis,20 cases in experimental group and 20 cases in con-trol group 20 cases in .①The analgesia score after operation＇The visual analogue score in the two groups was less than 4 points in 48 hours. ②The dosage of analgesic after operation：The dosage of fentanvl in the con-trol group was more than that in the experimental group [（1.32±0.06）, （0.46±0.03） mg,P 〈 0.05].③The effective pressure times of patient-controlled analgesia： It was similar in the two groups [experimental group： （44.57±4.01）times per 48 hours, control group：（47.15±4.25）times per 48 hours].④The level of sedation in the two groups：There were significant differences in the experimental group compared with the control group [exper- imental group：Ⅰ grade with 13 cas-es, Ⅱ grade with 5 cases,Ⅲ grade 2 cases; control group： Ⅰ grade 4 cas-es, Ⅱgrade 10 cases,Ⅲ grade 6 cases, P 〈 0.05].⑤Bad response： The occurrent proportion was significantly less in the experimental group than that in the control group. CONCLUSION： The lornoxicam can augment the analgesic effects of fentanvl after the ESS, remarkably reduce the dosage and bad response of fentanvl, and enhance the reliability and quality of analgesia
出处
《中国临床康复》
CSCD
北大核心
2005年第30期13-15,共3页
Chinese Journal of Clinical Rehabilitation
