摘要
目的观察不同自控静脉镇痛方案在开胸手术术后镇痛的有效性及安全性。方法择期行开胸手术患者120例,随机均分为四组,术后均行PCIA,镇痛方案分别为:舒芬太尼3μg/kg组(S组)、舒芬太尼1.5μg/kg+地佐辛0.3mg/kg组(SD组)、舒芬太尼1.5μg/kg+氟比洛芬酯3mg/kg组(SF组)和地佐辛0.3mg/kg+氟比洛芬酯3mg/kg组(DF组),四组均用0.9%生理盐水稀释至300ml持续泵注,持续给药量5ml/h,单次PCA剂量3ml,锁定时间15min。观察并记录患者术后2、4、8、24、48h的安静时和活动时VAS疼痛评分、Ramsay镇静评分、术后24h内PCA按压次数及不良反应。结果四组术后2、4、8、24和48h的安静时VAS疼痛评分及术后24h内PCA按压次数差异无统计学意义;与S组比较,术后2、4和8h时SD、SF和DF组在运动时VAS疼痛评分明显降低(P<0.05);与S组比较,术后2、4、8和24h时SD、SF和DF组的Ramsay镇静评分明显降低(P<0.05),不良反应明显减少(P<0.05)。结论与单用舒芬太尼比较,联合用药可以安全有效地用于开胸手术后镇痛,减轻早期运动痛,增强镇痛效果,减少不良反应。
Objective To investigate the efficacy and safety of the postoperative analgesia after thoracotomy with different patient-controlled intravenous analgesia （PCIA）medication.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients scheduled for elective thoracic surgery were randomly di-vided into four groups according to different PCIA formula：group S received sufentanil 3 μg/kg;group SD received sufentanil 1.5 μg/kg plus dezocine 0.3 mg/kg;group SF received sufentanil 1.5μg/kg plus flurbiprofen axetil 3 mg/kg;group DF received dezocine 0.3 mg/kg plus flurbiprofen ax-etil 3 mg/kg.For all four goups,the applied medicine was diluted with 0.9% saline to 300 ml,and was infused at 5 ml/h with a bolus dose of 3 ml.The lockout time was set at 1 5 min.The VAS and Ramsay sedation scale were recorded 2,4,8,24,48 h after surgery,respectively.Total pressing times and the side effects were also recorded for the 24 h period after the surgery.Results There were no significant differences of the VAS score at the time 2,4,8,24 and 48 h post surgery of press num-bers within 24 h postoperatively among all groups.The Ramsay sedation scale was significantly high-er at the time 2,4,8,24 h after surgery in group S than those in other three groups （P 〈0.05）.The side effects were more in group S than those in other three groups （P 〈0.05）.Conclusion Compared with sufentanil alone,combination therapy is safer and more effective for analgesia after thoracic sur-gery.With good outcomes and less side effects,it deserves more consideration in clinics.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第7期679-681,共3页
Journal of Clinical Anesthesiology
关键词
舒芬太尼
地佐辛
氟比洛芬酯
术后镇痛
开胸手术
Sulfentanil
Dezocine
Flurbiprofen axetil
Postoperative analgesia
Thoracic surgery
