地佐辛复合氟比洛芬酯或芬太尼用于开胸手术术后镇痛的比较

摘要

Objective To evaluate the efficacy and safety of dezocine combined with flurhiprofen axetil or fentanyl for postoperative patient-control led intravenous analgesia (PCIA) in patients undergoing thoracic surgery. Methods One hundred and twenty ASA T or H patients scheduled for clcctive thoracic surgery were randomly divided into three groups according to different PCIA formula; group A received fentanyl 0. 5 mg plus dezocine 30 mg;group B received dezocine 30 mg plus flnrbiprofen axetil 200 mg; group C received fentanyl 0.5mg plus flurbiprofen axetii 200 mg. Tropisetron 6mg was also added identically in all groups. Total PCIA volume was 100 saline with loading volume 2 ml,background volume 2 ml/h,bolus dose 0. 5 ml,and lockout time was set 15 mia The VAS, Prince-Henry and Ramsay sedation scale were recorded 2,4,8,24,48 h after surgery. Total pressing times 24 h postoperatively and the adverse effects were also recorded. Results Prince-Henry scale and VAS score 2h,4h after surgery and total PCIA pressing times were higher in group A than group B and C without difference between group B and C(P<0. 05). The Ramsay sedation scale was lower 2h postoperatively but higher 4,8, and 24 hours after surgery in group A than in group B and C (P<0. 05). Conclusion Dezocine combined with flurbiprofen axetil for postoperative patient-controlled intravenous analgesia (PCIA)is effective and safe than dezocine combined with fentanyl in palients undergoing thoracic surgery%目的 比较地佐辛复合氟比洛芬酯或芬太尼用于开胸手术患者术后自控静脉镇痛(PCIA)的效果.方法 择期行开胸手术患者120例,随机均分为三组,术后均行PCIA,镇痛药配方分别为地佐辛30 mg+芬太尼0.5 mg(A组),地佐辛30 mg+氟比洛芬酯200 mg(B组),芬太尼0.5mg+氟比洛芬酯200 mg(C组),均加入托烷司琼6mg,且用生理盐水稀释至100 ml,初始负荷剂量2 ml,背景剂量2ml/h,单次PCA剂量0.5ml,锁定时间15 min.观察并记录患者术后2、4、8、24、48h的VAS疼痛评分、Prince-Henry疼痛评分、Ramsay镇静评分,以及术后24 h内PCA按压次数和不良反应.结果 术后2、4h,A组VAS疼痛评分、Prince-Henry疼痛评分和术后24 h内PCA按压次数明显高于B、C组(P＜0.05).术后2h,A组Ramsay镇静评分明显低于B、C组,术后4、8、24 h高于B、C组(P＜0.05).结论 地佐辛复合氟比洛芬酯可以安全有效地用于开胸手术术后镇痛,而地佐辛复合芬太尼在术后最初数小时内镇痛效果欠佳,不良反应偏高.