小剂量硫酸镁复合芬太尼术后静脉镇痛

目的比较小剂量硫酸镁联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者90例,随机均分为三组,每组30例,以一次性静脉镇痛泵(2m l/h)分别行静脉术后镇痛,F组:单纯芬太尼镇痛,0.2μg/(kg.h)芬太尼+5 mg氟哌利多,MF1组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+0.5 mg/(kg.h)硫酸镁+5 mg氟哌利多,MF2组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+1 mg/(kg.h)硫酸镁+5 mg氟哌利多,各组镇痛泵中药物均用医用盐水稀释至100 m l,观察各组患者镇痛48 h内的静息镇痛评分(VAS方法),恶心呕吐,皮肤瘙痒和尿潴留的发生情况。结果三组患者的静息镇痛评分在12 h内MF1组和MF2组明显低于F组(P<0.05),而在12 h后没有明显差别(P>0.05);恶心呕吐,皮肤瘙痒和尿潴留发生率MF1组和MF2组显著低于F组(P<0.01)。MF1组和MF2组之间在静息镇痛评分和并发症发生方面没有明显差别。结论小剂量硫酸镁用于术后静脉镇痛可明显减少芬太尼的剂量,使恶心呕吐,皮肤瘙痒和尿潴留发生率降低,镇痛效果明显优于单纯芬太尼术后静脉镇痛。

Application of Small Dose of Magnesium Sulfate Combined with Fentanyl for Postoperative Analgesia

Objective To investigate the postoperative analgesic effect of fentanyl combined with a small dose of magnesium sulfate.Methods Ninety patients after upper abdominal operation who would undergo postoperative intravenous analgesia were randomly divided into three groups(n=30/group).Group F was administered with 0.2 μg/kg·h-1 of fentanyl plus 5 mg of droperidol,Group MF1 with fentanyl(0.2 μg/kg·h-1),magnesium sulfate(0.5 mg/kg·h-1) and droperidol(5 mg),and Group MF2 with fentanyl(0.2 μg/kg·h-1),magnesium sulfate(1 mg//kg·h-1) and droperidol(5 mg).The drugs in each group were diluted in 100 ml of normal saline and adminisered with a disposable perfusion pump at a speed of 2 ml/h.The static pain scores and the incidences of nausea,vomiting,itching and urinary retention were recorded within the first 48 hours' postoperative intravenous analgesia.Results The static pain scores of Group MF1 and Group MF2 during the first 12 hours were significantly lower than that of Group F(P<0.05),but they became similar after 12 hours.The incidences of nausea,vomiting, itching and urinary retention in Group MF1 and Group MF2 were also significantly lower than that of Group F(P<0.01).There were no obvious differences in the static pain score and the adverse effects between Group MF1 and Group MF2.Conclusion A small dose of magnesium sulfate used for postoperative intravenous analgesia can reduce fentanyl requirement,and also reduce the incidences of nausea,vomiting,itching and urinary retention.The analgesic effect of this method is better than that of fentanyl alone.