术后神经、精神系统障碍与术后镇痛镇静药物的合理应用

目的通过回顾性分析,研究术后镇痛治疗中的神经、精神系统障碍等不良反应与使用镇痛镇静药物及其他因素之间的关系,从而确定适合口腔颌面外科手术后的镇痛镇静药物。方法统计分析4 372例术后应用镇痛治疗中59例所发生的不同不良反应(精神异常、锥体外系征、恶心呕吐)与应用不同镇痛镇静配伍药物之间的关系。结果芬太尼 氟哌啶组及吗啡 氟哌啶组在较年轻的正颌整形外科手术患者术后出现明显的锥体外系征等不良反应,吗啡配伍氟哌啶组在老年显微血管外科患者的精神异常发生率明显高于其他组。单纯吗啡组、曲马朵组恶心呕吐率增加,给予昂丹司琼等对症治疗后无后遗症发生。结论术后合理应用镇痛镇静药物及抗恶心呕吐等药物可以减少不良反应的发生。

Effects of analgesics and sedatives applied in post-operation on neurotic and psychiatric system disorders

Objective To investigate the relationship between neurotic and psychiatric disorders and sedatives and analgesics as well as other factors during postoperative analgesia in maxilla-facial opera- tions.Methods Of 4 372 cases of postoperative analgesia with different sedatives and analgesias,59 cases were of neurotic and psychiatric disorders.Statistically analyzed 59 cases of different disorders(included psychiatric abnormality,extra-pyramidal sign,nausea and vomit,etc)with applications of analgesics and sedatives in postoperative administrations,and tried to find the correlations between the disorders and the various combinations of analgesics and sedatives.Results The incidence of abnormal extra-pyramidal sign and other disorders were increasing obviously in fentany droperidol group and morphine droperidol group in the patients with maxillofacial orthopedic operations.For the elder patients with microvascular operation, the highest frequency rate of psychiatric abnormalities was observed in morphine droperidol group.The occurrence rate of nauseas and vomits of morphine group and tramadol group was higher than that in other treatment groups.There was no complication happened after using ondansetron to treat the disorders. Conclusion Reasonable applications of analgesics and sedatives in post-operative administrations can reduce the occurrences of the disorders.