地佐辛和氟比洛芬酯联合术后自控静脉镇痛研究

目的 比较地佐辛、芬太尼、氟比洛芬酯联合地佐辛应用于术后患者静脉自控镇痛(PCIA)的有效性和安全性.方法 选择240例行择期手术,ASA分级Ⅰ～Ⅲ级,年龄18～65岁的患者.随机分为3组:地佐辛组(D组)、氟比洛芬酯+地佐辛组(FD组)、芬太尼组(F组)、每组各80例.术后行PCIA,地佐辛组(D组):负荷量地佐辛5 mg,镇痛泵为地佐辛1.0 mg/kg+昂丹司琼8 mg+0.9%氯化钠注射液;氟比洛芬酯+地佐辛组(FD组):负荷量氟比洛芬酯25 mg+地佐辛2.5 mg,镇痛泵为氟比洛芬酯1 mg/kg+地佐辛0.8 mg/kg+昂丹司琼8 mg+0.9%氯化钠注射液;芬太尼组(F组):负荷量芬太尼1 μg /kg,镇痛泵为芬太尼15 μg /kg+昂丹司琼8 mg+0.9%氯化钠注射液;容量均为100 ml.镇痛泵参数设定均为持续输注量2 ml/h,PCA量0.5 ml,锁定时间15 min.采用疼痛视觉模拟评分(VAS评分)和Ramsy镇静评级评估患者48 h内的疼痛程度和镇静情况,同时记录不良反应发生情况,并于术后4、12、24、48 h时采集外周静脉血测定血浆皮质醇浓度.结果 3组患者均获得良好的镇痛效果,各组在同时点的疼痛视觉模拟评分(VAS)无显著差异(P>0.05),各组在同时点的Ramsy镇静评级无显著差异(P>0.05),各组在同时点的血浆皮质醇无显著差异(P>0.05).各组均存在不良反应,但芬太尼组不良反应发生率显著高于其他两组(P<0.05);氟比洛芬酯-地佐辛组的不良反应发生率显著低于其他两组(P<0.05).结论 地佐辛与氟比洛芬酯联合用于术后PCIA能达到满意的镇痛效果,同时可减少不良反应,是一种可行、安全、有效的镇痛方法.

Effect of dezocine and flurbiprofen axetil used in combination for patient-controlled intravenous analgesia following surgery

Objective To evaluate the efficacy and safety of dezocine,fentanyl,dezocine combined flurbiprofen axetil,used for postoperative patient-controlled intravenous analgesia(PCIA)in patients undergoing surgery.Methods Two hundred and forty ASAⅠ~Ⅲ,eighteen-sixty five years old patients undergoing elective surgeries,were randomized equally into 3 groups: dezocine group(group D),dezocine combined flurbiprofen axetil group(groups FD),fentanyl group(group F),and all received postoperative PCIA.For postoperative PCIA,the patients in group D received a protocol of dezocine 5 mg as loading dose and dezocone(1.0 mg/kg) + ondansetron(8 mg)+ 0.9 %Nacl solution,those in group FD receive dezocine 2.5 mg combined flurbiprofen axetil 25 mg as loading dose and flurbiprofen axetil(1 mg/kg) +dezocone(0.8 mg/kg) + ondansetron(8 mg)+ 0.9% Nacl solution,And those in group F had a protocol of fentanyl 1 μg /kg as loading dose and fentanyl(15 μg /kg) + ondansetron(8 mg)+ 0.9% Nacl solution.All the anesthetic agents were diluted to 100 mI and infused by a pump at the background dose rate of 2 ml/h with a patient-controlled bolus of 0.5 ml and the lock out time of 15 min.The visual analogue scale(VAS)and Ramsay scores were used to evaluate the analgesic effect at 2,4,8,12,24 and 48 h after surgery.Plasma cortisol were detected at 4,12,24 and 48 h after surgery,and the adverse effects associated with PCIA were recorded in the 48 h post-operatively.Results All the patients showed good pain relief with PCIA.In three groups,the VAS scores did not indicate a statistically significant difference(P> 0.05),and in three groups,the differences of the average Ramsay score were not significant(P> 0.05).The plasma cortisol of three groups were not significant difference(P> 0.05).The incidence of adverse effect of group F was higher significantly than other 2 group(P<0.05),the incidence of adverse effect of group FD was lower significantly than other 2 group(P<0.05).Conclusion PCIA with a combination of flurbiprofen axeyil and produces satisfactory analgesic effect,and can significantly reduce adverse effects.