地佐辛复合舒芬太尼在乳腺癌根治术术后镇痛中的应用

摘要

目的：评价地佐辛复合舒芬太尼用于乳腺癌术后患者自控静脉镇痛（ PCIA）的可行性。方法 ASAⅠ-Ⅱ级乳腺癌根治术患者40例，随机分为2组：Ⅰ组为生理盐水组，手术结束前30 min注射生理盐水5 ml，术后PCIA使用舒芬太尼2μg/kg、托烷司琼4 mg；Ⅱ组为地佐辛组，手术结束前30 min注射地佐辛5 mg，术后PCIA使用舒芬太尼1μg/kg、地佐辛0．3 mg/kg、托烷司琼4 mg，均用生理盐水稀释为100 ml。记录术后1、4、8、244、8 h的视觉模拟镇痛评分（ VAS）、Ramsay镇静评分及嗜睡、恶心、呕吐等不良反应发生情况。结果术后各时间点的VAS评分2组间差异无统计学意义（P＞0．05），但Ⅱ组患者Ramsay镇静评分及患者术后的总体满意度显著优于Ⅰ组（P＜0．05），且不良反应少。结论地佐辛复合舒芬太尼用于乳腺癌根治术术后PCIA的效果良好，且能明显减少舒芬太尼的用量，同时降低不良反应的发生。%Objective To evaluate the feasibility of a combination of dezocine and sufentanil for patient controlled intravenous analgesia (PCIA) after breast cancer radical mastectomy.Methods 40 ASA Ⅰ-Ⅱ patients undergoing breast cancer masterctomy were randomly divided into two groups .GroupⅠreceived 5 ml of normal saline 30 min prior to surgery, and then 2μg/kg sufentanil and 4 mg tropisetron for post-operative PCIA.GroupⅡwas injected with 5 mg of dezocine 30 min prior to surgery, and then 1μg/kg sufentanil, 0.3 mg/kg dezocine and 4 mg tropisetron (each dilu-ted with saline to 100 ml) for post-operative PCIA.Next, the visual analogue scale ( VAS) and the Ramsay sedation scale were scored 1, 4, 8, 24, and 48 hours after surgery.Meanwhile, drowsiness, nausea, vomiting and other adverse reactions were recorded .Results No statistical differences were found in the VAS scores of both groups at each time point (P>0.05).However, Group II reported remarkably superior satisfaction and the Ramsay sedation scores over GroupⅠ(P<0.05), with less adverse reaction.Conclusion A combination of dezocine and sufentanil is effective for PCIA after breast cance radical mastectomy .The combined therapy can significantly reduce the dosage of sufentanil , while reduce adverse events .