地佐辛应用于超高龄髋关节手术术后镇痛60例

目的观察地佐辛应用于超高龄髋关节手术患者术后静脉镇痛的安全性和有效性。方法选取拟行髋关节骨折内固定手术的80岁以上超高龄患者120例,美国麻醉医师协会（ASA）分级Ⅰ-Ⅲ级,随机均分为2组。D组手术结束前给予地佐辛5 mg,术后患者自控镇痛（PCA）镇痛液含地佐辛0.5 mg/kg。S组手术结束前给予舒芬太尼5μg,术后PCA镇痛液含舒芬太尼1.5μg/kg。分别记录术后疼痛视觉模拟评分法（VAS）评分、Ramsay镇静评分,术后镇痛期间恶心呕吐、眩晕、呼吸抑制、嗜睡等不良反应发生率。结果两组镇痛效果满意,除术后24 h D组VAS评分低于S组外,其余各时间点两组VAS评分无显著差异;各时间点两组Ramsay镇静评分无显著差异;D组恶心发生率低于S组,两组呕吐、嗜睡、眩晕、皮肤瘙痒的发生率均无显著差异。结论地佐辛、舒芬太尼经静脉患者自控镇痛（PCIA）法用于超高龄髋关节手术术后镇痛均可获得满意镇痛效果,但地佐辛不良反应发生率低于舒芬太尼,是一种较好的针对超高龄老年髋关节手术患者术后镇痛的方法。

Study on Application of Dezocine in Postoperative Analgesia of Super-Aged Patients with Hip Surgery in 60 Cases

Objective To investigate the safety and effectiveness of dezocine used in postoperative patient controlled intravenous analgesia（ PCIA） in the super- aged patients with hip surgery. Methods 120 super- aged patients（ ASA Ⅰ to Ⅲ） with age of ≥ 80 years undergoing the internal fixation operation of hip fracture were randomly divided into 2 groups. The group D was given dezocine 5 mg before the end of operation and the postoperative patient controlled analgesic（ PCA） solution contained dezocine 0. 5 mg / kg. The group S was given sufentanil 5 μg before the end of operation and the postoperative PCA solution contained sufentanil 1. 5 μg / kg. The postoperative VAS score and the Ramsay sedation score were recorded. And the occurrence rates of the adverse reactions of nausea and vomiting, vertigo, respiration depression and drowsiness were recorded too. Results The analgesic effects in the two groups were satisfactory. Except the VAS scores at postoperative 24 h in the group D were lower than those in the group S,the VAS scores at other timepoints had no statistically significant difference between the two groups. There was no statistically significant difference in the Ramsay sedation scores at various timepoints between the two groups. The occurrence rate of nausea in the group D was significantly lower than that in the group S; the occurrence rates of vomiting,drowsiness,vertigo and skin itching had no statistical differences between the two groups. Conclusion Dezocine and sufentanil PCIA can obtain the satisfactory effect in the postoperative analgesia of the super- aged patients with hip operation. The occurrence rate of adverse reactions in dezocine is lower than that in sulfentanil,which is a better postoperative analgesic method for super- aged hip operation.