不同剂量纳洛酮复合芬太尼用于老年人工髋关节置换患者术后自控静脉镇痛效果的比较

目的 探讨不同剂量纳洛酮复合芬太尼用于老年人工髋关节置换患者术后自控静脉镇痛的效果.方法 择期行人工髋关节置换术的老年患者80例,随机分为4组(n=20):F组、FN1组、FN2组、FN3组.所有患者均采用蛛网膜下腔-硬膜外联合麻醉,术后行患者自控静脉镇痛,镇痛时间48 h.4组镇痛泵配置方案依次为:芬太尼15μg/kg(F组)、芬太尼15μg/kg+纳洛酮2.4μg/kg(FN1组)、芬太尼15μg/kg+纳洛酮4.8μ g/kg( FN2组)、芬太尼15μg/kg+纳洛酮7.2μg/kg( FN3组),均加生理盐水配制成100 mL.分别于术后2、4、6、24、48h记录静息及运动时视觉模拟评分(VAS)、芬太尼用量、Ramsay评分、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2)；记录术后镇痛期间曲马多追加情况、48h后患者镇痛总体满意度评分、术后恶心、呕吐及托烷司琼使用情况、胃肠蠕动恢复时间、头晕、皮肤瘙痒、呼吸抑制发生情况.结果 四组患者术后镇痛期间生命体征平稳,均取得了满意的术后镇痛效果,四组不同时点静息及运动时VAS评分、Ramsay评分、芬太尼用量组间比较无差异(P＞0.05)；与F组比较,FN1组、FN2组、FN3组恶心呕吐的发生率较低(P＜0.05),但3组间比较无差异(P＞0.05)；F组术后使用托烷司琼的例数高于FN1组、FN2组、FN3组(P＜0.05);四组皮肤瘙痒发生的例数组间比较无差异(P＞0.05)；四组均未出现过度镇静及呼吸抑制患者.结论 小剂量纳洛酮可减少芬太尼引起的不良反应,同时不影响其镇痛效果,小剂量纳洛酮复合芬太尼可安全有效的用于老年人工髋关节置换患者术后自控静脉镇痛.

Effects of different dose naloxone combined with fentanyl for postoperative patient-controlled intravenous analgesia in elderly patients undergoing artificial hip replacement

【Objective】 The purpose of this study was to investigate the effect and safety of ultra-low-dose combined with fentanyl for patient-controlled intravenous analgesia in elderly patients undergoing hip replacement.【Methods】 This double-blind study enrolled 80 patients who were scheduled for hip replacement under combined spinal and epidural anesthesia.Patients were randomly divided into four groups(n =20 for each group).Patients received PCIA with 15μg/kg fentanyl with no naloxone(group F),2.4μg/kg naloxone(group FN1),4.8 μg/kg naloxone(group FN2) and 7.2μg/kg naloxone(group FN3).Visual analog scales(VAS) for pain during rest and motion,Ramsay sedation score(RSS) for sedation,MAP,HR,RR and SpO2 were assessed at 2,4,6,24 and 48 h postoperatively.The scores of satisfaction of postoperative analgesia and fentanyl-related side effects including nausea,vomiting,pruritus,respiratory depression and dizziness were also recorded.【Results】 During the course of analgesia,the vital signs of 4 groups were stable.The pain scores(at rest and motion),Ramsay sedation score and fentanyl consumption were not significantly different among the four groups.Compared with group F,the incidence of nausea and vomiting was significantly lower in group FN1,FN2,FN3 during the postoperative 48 h(P <0.05).The rescue antiemetic requirements was significantly lower in group FN1,FN2,FN3 than in group F(P <0.05).However,there were no significant differences between group FN1,FN2,FN3.There was no report of fentanyl-related respiratory depression or somnolence(sedation score≥5) in all groups.【Conclusion】 Ultra-low-dose naloxone infusion could reduce fentanyl induced side effects without reversing its analgesic effects,ultra-low-dose naloxone combined with fentanyl is safe and effective for postoperative patient-controlled intravenous analgesia in elderly patients undergoing hip replacement.