凯芬复合地佐辛超前镇痛对腹腔镜直肠癌术后镇痛的影响

摘要

Objective: To observe kyffin combined pholcodine for preemptive analgesia on epidural anesthesia with postoperative patient-controlled intravenous analgesia effect of laparoscopic resection of rectal cancer. Method: Elective general anesthesia abdominal mirror rectal cancer operation patients 90 cases, ASA Ⅰ or Ⅱ level, random are is divided into three group: ahead of analgesia Group ( group A ), Before surgery cut skin 5min slow vein push note Kyffin 100mg and to pholcodine 10mg; Analgesia after operation group ( group B ), in surgery end closed abdominal Shi vein slow push note Kyffin 100mg and to Pholcodine 10 mg; control group ( group C ), Prior to the surgical incision and skin for 5 min slow vein push note saline 10ml. Three groups of joints in patients with slow intravenous injection of fentanyl at 0. 05 ~0.1mg. All patient-controlled intravenous analgesia ( PICA ), the analgesic morphine in liquid 0. 02% , PICA is set to load dose 5 mL dose 2 ml/h background, append, dose 1 ml each time of LCP mode, lock time to 10 min, analgesic and 48h. Individually recorded resting pain in the wound, and dynamic VAS pain score, opening PICA press the number of the pump after pump ( Dl ) and the actual number of valid press ( D2 ), Ramsay sedation score, Bromage improved ratings and the incidence of adverse reactions. Result: Three PICA in patientswith significantly lower than morphine consumption during A group B, group C( P<0. 05 ), after Agroup of 1 , 4 , 8 , 16 , static and dynamic 24h and VAS pain score significantly lower than B, C Group ( P<0. 05 ). A group of 4 h after static VAS score significantly lower than group C(P<0.05), 1-4 hours, 4-8 hours A group Dl and D2 in patients with significantly less than B, C Group ( P<0.05 ). Conclusion: Prior to the surgical incision and skin for 5 minu slow intravenous injection of laparoscopic resection of rectal cancer, reducing the analgesic dose of PICA, prolonged pain, less adverse reaction, and in clinical use.%目的:观察凯芬复合地佐辛超前镇痛对全麻下腹腔镜直肠癌术后静脉自控镇痛效应的影响.方法:择期全麻腹腔镜直肠癌术患者90例,ASAⅠ或Ⅱ级,随机均分为三组:超前镇痛组(A组),于手术切皮前5min缓慢静脉推注凯芬100mg和地佐辛10mg;术后镇痛组(B组),于手术结束关腹时静脉缓慢推注凯芬100mg和地佐辛10 mg;对照组(C组),于手术切皮前5 min缓慢静脉推注生理盐水10mL.三组患者均在缝皮时缓慢静脉推注芬太尼0.05-0.1mg.均行静脉自控镇痛(PICA),镇痛液为0.02%吗啡,PICA采用设置为负荷剂量5 mL、背景剂量2 mL/h、追加剂量每次1 mL的LCP模式,锁定时间10 min,镇痛48h.分别记录伤口静息疼痛和动态疼痛的VAS评分、开启PICA泵后各时段PICA泵的按压次数(D1)和实际有效按压次数(D2)、Ramsay镇静评分、改良Bromage分级及不良反应的发生率.结果:三组患者PICA期间吗啡用量A组明显低于B、C组(P<0.05),A组术后1、4、8、16、24h及48h静态和动态疼痛VAS评分明显低于B、C组(P<0.05).A组术后4 h静态VAS评分明显低于C组(P<0.05);在1-4 h、4-8 h时段中A组患者D1及D2明显少于B、C组(P<0.05).结论:在手术切皮前5 min缓慢静脉推注凯芬100mg和地佐辛10 mg超前镇痛可有效增强全麻腹腔镜直肠癌术后静脉自控镇痛效应,减少PICA镇痛药量,镇痛时间延长,不良反应较少,值得在临床应用.