酮咯酸氨丁三醇复合小剂量芬太尼与咪唑安定混合舒芬太尼在LC术后PCIA中的应用效果比较

摘要

[目的]比较酮咯酸氨丁三醇复合小剂量芬太尼与咪唑安定混合舒芬太尼在腹腔镜胆囊切除术(LC)术后患者静脉自控镇痛(PCIA)中的应用效果.[方法]选取2014年11月至2016年11月于本院就诊的行 LC患者86例,随机分为2组各43例.A组予以咪唑安定混合舒芬太尼,B组予以酮咯酸氨丁三醇复合小剂量芬太尼,观察两组术后4 h、8 h、12 h、24 h PRINCE-ENRY评分,RAM-SAY镇静评分,总体镇痛效果,PCA镇痛次数及不良反应发生率.[结果]B组术后4 h、8 h、12 h、24 h PRINCE-ENRY评分和RAM-SAY镇静评分低于A组(P <0. 05);B组术后总体镇痛效果在Ⅰ级所占比例明显高于 A组,Ⅳ级所占比例明显低于 A 组(P <0.05);B组 PCA总次数少于 A组(P <0.05);B组不良反应发生率明显低于 A组,差异均具有统计学意义(P <0.05).[结论]LC术后采用酮咯酸氨丁三醇复合小剂量芬太尼与咪唑安定联合舒芬太尼镇痛,均可达到一定效果,相较而言,酮咯酸氨丁三醇复合小剂量芬太尼术后镇痛效果更佳,同时还可抑制阿片受体所产生的不良反应.%[Objective]To compare the effects of ketorolac tromethamine combined with low dose fentanyl and midazolam in combination with sufentanil in patient-controlled intravenous analgesia (PCIA)after laparoscopic cholecystectomy (LC).[Methods]A total of 86 patients with LC who admitted to our hospital from November 2014 to November 2016 were randomly divided into two groups,with 43 cases in each group.Patients in group A were treated with midazolam combined with sufentanil,while patients in group B received ketorolac tromethamine combined with a lower dose of fentanyl.The PRINCE-ENRY score,RAM-SAY sedation score,analgesic effect, overall PCIA analgesia and the incidence of adverse reactions at 4h,8h,12h and 24h after surgery were observed in the two groups.[Results]The PRINCE-ENRY score and RAM-SAY sedation score at 4h,8h,12h,24h after sur-gery in group B were lower than those in group A;the difference between groups was significant statistically (P<0.05).The overall postoperative analgesic effect of group B in terms of the proportion of level Ⅰ was significant-ly higher than that of group A,while the proportion of level Ⅳ in group B was significant lower than that in the group A;the difference between groups was statistically significant (P <0.05).The total number of PCIA in group B was less than that in group A(P <0.05).The incidence of adverse reactions in group B was significantly lower than that in group A,and the difference was statistically significant(P <0.05).[Conclusion]The use of ke-torolac tromethamine combined with fentanyl as well as midazolam combined with sufentanil can achieve certain effect after laparoscopic cholecystectomy.The combination of ketorolac tromethamine and low-dose fentanyl has relatively better postoperative analgesic effect and can also inhibit the opioid receptor induced adverse reactions.