[目的]探讨肝功能不全患者使用喷他佐辛在术后镇痛时的最佳使用剂量.[方法]选取45例肝硬化,脾亢,门脉高压拟行脾切除,门奇静脉断流术的患者,随机分成A,B和C三组,分别用喷他佐辛单位时间剂量0.5 μg/(kg·min),0.75 μg/(kg·min)和1.0 μg/(kg·min),每组止痛泵内均复合托烷司琼10 mg,总容量为100 mL,每组均以2 mL/h的速度持续静脉泵入.记录患者连接止痛泵后2,4,8,12,24,32 h的视觉模拟评分(VAS),Ramesay镇静评分,不良反应和患者对镇痛效果综合评价.[结果]三组均获得了良好的镇痛效果,VAS疼痛评分各时间段都＜2分.三组患者术后24 h内各时点VAS、Ramsay评分相比差异无显著性(P＞0.05);三组患者对PCA满意度综合评价A组与 B组、C组相比较差异有显著性(P＜0.05);三组不良反应的发生率C组与A组、B组相比较差异有显著性(P＜0.05).[结论]喷他佐辛0.75 μg/(kg·min)用于合并肝功能不全的患者术后静脉镇痛效果确切,镇静效果好,不良反应少.%[Objective]To explore the best dosage of intravenous pentazocine for postoperative analgesia in patients with hepatic insufficiency. [Methods]Forty-five patients with liver cirrhosis, hypersplenism and portal hypertension who underwent splenectomy and portal azygous disconnection were selected and divided into group A, B and C randomly. Three groups received pentazocine with the dose of 0.5 μg/(kg · min), 0.75 μg/(kg · min) and 1.0 μg/(kg · min) , respectively. The analgesia pump in every group was combined with 10ug tropisetron which the total dose was 100mL. The velocity of continuously intravenous pumping in each group was 2mL/h. The visual analog scale(VAS), Ramesay sedation score, side effects and patients' evaluation for the analgesia efficacy were recorded at 2, 4, 8, 12, 24 and 32h after connecting the analgesia pump. [Results]All the three groups had good analgesia effect, and the VAS scores were lower than 2. VAS and Ramsay scores at each time point within 24h after operation showed no significant difference among the three groups( P＞0.05). There was significant difference in the comprehensive evaluation of satisfaction for PCA between group A and group B and C( P ＜0.05). There was also significant difference in the incidence of adverse teac tions between group C and group A and B( P ＜0.05). [Conclusion] Pentazocine with the dose of 0.75μg/kg.min for intravenous analgesia after operation of patients with hepatic insufficiency has certain effect, good se dation efficacy and less adverse reactions.
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