不同剂量酮咯酸对老年患者舒芬太尼术后镇痛效果的影响

摘要

Objective To evaluate the influence of different dosages of ketorolac tromethamine on postoperative analgesia efficacy with sufentanil in elderly patients.Methods One hundred and twenty elderly patients undergoing selective laparoscopic hepatobiliary surgeries were included in this study and randomly divided into 3 groups (n=40 each):sufentanil group (group S),sufentanil plus ketorolac tromethamine group 1 (group SK1) and sufentanil plus ketorolac tromethamine group 2 (group SK2).Patients in all three groups were received 0.2 μg/kg sufentanil as a loading dose at 30 min before the end of operation,then were given patientcontrolled intravenous analgesia (PCIA) immediately after the operation.150 ml solution in the PCA reservoir contained sufentanil 3 μg/kg.15 mg,or 30 mg of ketorolac tromethamine were given by intramuscular injection per 6 hours in group SK1 and group SK2 immediately after the operation respectively.VAS was assessed at 2,4,8,12,24 and 48 h after the operation.The consumption of sufentanil and adverse effects were also recorded.Results VAS was lower in group SK1 at 2,24 h after the operation compared with group S (P ＜ 0.05).And VAS was significantly lower in group SK2 than that in other two groups at 8,12,24,48 h after the operation (P ＜ 0.05).The dose of sufentanil was decreased 5.3％ and 13.5％ in group SK1 and group SK2 than that in group S within 48 h after the operation respectively.Conclusion Ketorolac tromethamine combined with sufentanil can be safely and effectively used for postoperative analgesia in elderly patients,and the consumption of sufentanil was decreased,while 30 mg ketorolac tromethamine is the best dose.%目的 评价不同剂量酮咯酸氨丁三醇对老年患者舒芬太尼术后镇痛效果的影响.方法 选择择期腹腔镜肝胆手术的老年患者120例,采用随机数字表法分为3组(n=40):舒芬太尼组(S组)、舒芬太尼复合酮咯酸1组(SK1组)、舒芬太尼复合酮咯酸2组(SK2组).各组于手术结束前30 min静脉给予舒芬太尼0.2 μg/kg.术毕均连接镇痛泵,内含舒芬太尼3μg/kg,总容量150 ml.SK1、SK2组于术毕开始每6小时分别肌注酮咯酸氨丁三醇15、30 mg.记录患者术后2、4、8、12、24及48 h时VAS评分、舒芬太尼用量及不良反应.结果 SK1组患者仅在术后4、24 h时VAS评分低于S组(P＜0.05);而SK2组术后8、12、24及48 h时VAS评分均低于其他两组(P＜0.05);术后48 h时,SK1组及SK2组舒芬太尼用量较S组分别减少5.3％和13.5％(P＜ 0.05).结论 酮咯酸氨丁三醇复合舒芬太尼可安全、有效地用于老年患者术后镇痛,并可减少舒芬太尼的剂量,其中肌注酮咯酸氨丁三醇30 mg时,镇痛效果更为显著.