基于不同给药方式 3种镇痛药物的临床效果比较

为了从有效性、安全性和经济性方面对不同给药方式将3种镇痛药物用于普外科术后镇痛的临床效果进行评价。回顾2015年2月至2016年2月间在我院行全麻共896例开腹手术的患者。根据术后镇痛方案，将患者分为3组：地佐辛组、芬太尼组和基础镇痛组。分析患者术后72 h内随访记录，包括6、24、48、72 h的静态和动态疼痛评估、睡眠质量评估、镇痛药物相关不良反应的发生率、术后胃肠功能恢复情况和每组镇痛方案的成本。结果表明，芬太尼组的静态、动态疼痛分数低于地佐辛组，且差异有统计学意义（P＜0.001）。而地佐辛组的静态、动态疼痛分数与基础镇痛组的差异无统计学意义（P>0.05）。地佐辛组的恶心呕吐发生率显著高于芬太尼组和基础镇痛组（28.5% vs. 19.7% vs. 11.4%）。在排便时间和接受流质的时间，3组间没有显著差异。另外，芬太尼组的镇痛成本是3组中最低的。总之，芬太尼静脉自控镇痛不仅可以有效地缓解疼痛，且不良反应和成本均较低。在临床上应根据患者术后疼痛情况及其付费意愿选择最优的镇痛方案。

A Retrospective Observation Study Comparing Three Analgesic Drugs Based on Different Administration Methods after Surgery

The effects and safety of the continuous intravenous dezocine, the fentanyl-based IV-PCA and the basic pain treatment for major open abdominal surgery were assessed in a retrospective review of 896 patients over a 1-year period. We tested a hypothesis of noninferiority of continuous intravenous dezocine to fentanyl-based IV-PCA and basic pain treatment for controlling postoperative pain. Analgesia effects were measured including patient self reported pain scores both at rest and during movement within 3 days after surgery. Safety of pain management methods assessment included incidence of adverse effects. The recovery of gastrointestinal function and the institution cost of each treatment modalities were also compared. There were significantly diferences in mean of pain scores at rest and during movement between the fentanyl group and the dezocine group (P<0.001), there were no significant differences between the dezocine group and the basic treatment group (P>0.05). However, the incidences of nausea and vomiting in the dezocine group were higher than those in the fentanyl group and the basic pain treatment group (28.5% vs. 19.7% vs. 11.4%). The time to tolerating liquid diet and the time to bowels open were similar in the three groups. The institution cost was lowest in the fentanyl group. Considering respective pain profiles, incidences of side effects and institutional costs associated with the three analgesic regimens analyzed, fentanyl-based IV-PCA constitutes an effective and economic pain management modality after major abdominal surgery. Dezocine can be a useful alternative to fentanyl-based IV-PCA, but the cost is expensive. However, patients treated with fentanyl based IV-PCA may need additional NSAIDs for the 48-72 hours postoperatively.