小剂量纳美芬在老年髋部骨折患者术后静脉自控镇痛中的应用

目的 观察小剂量纳美芬对舒芬太尼复合地佐辛静脉自控镇痛效果和不良反应的影响。方法 选取拟行髋部骨折手术的老年患者80例,采用数字表法随机分为两组,在手术结束后分别使用托烷司琼+舒芬太尼+地佐辛(T组)以及纳美芬+舒芬太尼+地佐辛(N组)的静脉自控镇痛泵。在术后48 h内不同时点进行疼痛视觉模拟评分(Visual Analogue Scale,VAS),观察不良反应的发生情况,并记录两组患者的有效按压次数。结果 镇痛效果:术后纳美芬组的VAS镇痛评分低于托烷司琼组,差异有统计学意义(P<0.05)。纳美芬组的有效按压次数低于托烷司琼组,差异有统计学意义(P<0.05)。不良反应:纳美芬组的恶心、呕吐、头晕、嗜睡及呼吸抑制的发生率均低于托烷司琼组,但只有恶心、呕吐、头晕的发生率两组间差异有统计学意义(P<0.05)。结论 对于老年患者,小剂量的纳美芬较托烷司琼可以增强舒芬太尼复合地佐辛的镇痛效果,在一定程度上降低不良反应,提高术后镇痛的安全性。

Application of low-dose nalmefene in postoperative patient-controlled intravenous analgesia of elderly patients with hip fracture

Objective To observe the effects of low-dose nalmefene on the postoperative analgesia and side effects of sufentanil and dezocine.Methods Eighty elder patients undergoing hip operations under spinal anesthesia (SA) and given patient-controlled intravenous analgesia(PCIA) were randomly divided into two groups (n=40 each group).Group T was given sufentanil and dezocine plus tropisetron for PCIA, group N was given sufentanil and dezocine plus low-dose nalmefene.The Visual Analogue Scale(VAS) pain scores of two groups were assessed at 2h, 4h, 8h, 12h, 24h, 48h after operation.The side effects and pressing times of PCA were observed and recorded as well.Results The VAS scores in the group N were statistically lower than that of group T postoperatively (P<0.05).The pressing times of PCA in group N was less than that in group T(P<0.05).The incidence of nausea and vomiting, dizziness in group N was significantly lower than group T (P<0.05).There was no occurrence of drowsiness and respiratory depression in group N, but no statistical significance compared with group T.Conclusion Compared with tropisetron, low-dose nalmefene can enhance the analgesic effect safely and reduce the incidence of side effects of sufentanil and dezocine to some extent in elder patients.