地佐辛复合舒芬太尼用于全麻开胸患者术后静脉镇痛的临床观察

目的观察比较地佐辛复合舒芬太尼用于全麻患者开胸术后自控静脉镇痛的效果。方法选择择期ASAⅠ或Ⅱ级全麻开胸手术患者60例,年龄20~60岁,随机分为3组。舒芬太尼组(S组,20例,舒芬太尼3.5μg/kg+昂丹司琼24 mg);地佐辛组(D组,20例,地佐辛0.8 mg/kg+昂丹司琼24 mg);地佐辛复合舒芬太尼组(SD组,20例,地佐辛0.4 mg/kg+舒芬太尼1.75μg/kg+昂丹司琼24 mg);均用生理盐水稀释到100 m L。各组均采用微量注射泵静脉输注右美托咪定负荷剂量1μg/kg麻醉诱导,15 min泵注完,静注舒芬太尼0.2~0.4μg/kg、丙泊酚1.5~2 mg/kg、罗库溴铵1 mg/kg后气管插管,麻醉维持以右美托咪啶0.2μg/(kg·h)持续泵注、吸入1.5%~2.5%七氟烷、泵注丙泊酚2~3 mg/(kg·h)和间断静注罗库溴铵0.2~0.3 mg/kg。术毕接PCIA泵,参数设定均以2 m L/h持续静脉泵入,单次量0.5 m L,锁定时间15 min。监测治疗前(T0)及治疗后4 h(T_1)、8h(T_2)、12 h(T_3)、24 h(T_4)、36 h(T_5)的SBP、DBP、HR、RR、Sp O2。并记录VAS镇痛评分、Ramsay镇静评分。观察患者不良反应、患者满意度等。结果 T0~T4时SD组RR低于S组和D组,差异有统计学意义(P<0.05);T0~T5时SD组Sp O2低于S组和D组,差异有统计学意义(P<0.05)。T1~T5时SD组Ramsay镇静评分低于S组和D组,差异有统计学意义(P<0.05)。SD组不良反应发生率低于S组,满意度优秀率高于S组和D组,差异有统计学意义(P<0.05)。结论地佐辛复合舒芬太尼用于全麻开胸患者术后静脉镇痛,两药在药效上有很好的协同作用,使患者心血管系统平稳,呼吸抑制轻微,镇痛效果确切,不良反应少。

Clinical observation on dezocine combined with sufentanil for patient-control intra-venous analgesia after thoracic surgery under general anesthesia

Objective To observe the advantage of dezocine combined with sufentanil for patient-control intra-venous analgesia after thoracic surgery under general analgesia. Methods Sixty cases of thoracic surgery patients were selected,ASA grades Ⅰ or Ⅱ,aged 20 ~60 years,were randomly divided into three groups. Contrast group: group S (n=20,sufentanil 3. 5 mg+ondanstron 24 mg+NS=100 mL) and group D (n=20,dezocine 0. 8 mg/kg+ondan-stron 24 mg+NS=100 mL);experimental group:group DS (n=20,dezocine 0. 4 mg/kg+sufentanil 1. 75 μg/kg+ondanstron 24 mg+NS=100 mL) . Each mixed liquid was injected to PCIA pump. All patients were induced intrave-nous injection of Dex (1 μg/kg) for 15 minutes directly and then received continuous injection of Dex at a rate of 0. 2 μg/( kg·h) . Then they were induced propofol 1. 5 ~ 2 mg/kg, sufentanil 0. 2 ~ 0. 4 μg/kg and rocuronium 1 mg/kg,maintained with inhalated sevflurane 1. 5% ~2. 5%,propofol 2~3 mg/( kg·h) and intermittent rocuronium 0. 2 ~0. 3 mg/kg. All patients received 2 mL per hour and incremental dose of 0. 5 mL per 15 minutes. SBP,DBP,HR, RR and SpO2 of the patients were monitored. Pain score ( Visual Analogue Scale,VAS) ,sedation score ( Ramsay) ,side reactions and satisfaction degree were recorded at 0 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h(T4) and 36 h(T5). Results RR of group SD at T0 ~T4 were lower than those of group S and group D (P<0. 05). SpO2 of group SD at T0 ~T5 were lower than those of group S and group D (P<0. 05). Ramsay score of group SD at T1 ~T5 were lower than those of group S and group D (P<0. 05). The incidence of adverse reactions in group SD was lower than that in group S,while satisfactory rate was higher than that of group S and group D (P<0. 05). Conclusion Dezocine com-bined with sufentanil for patient-control intravenous analgesia after thoracic surgery under general anesthesia has good synergistic effects,resulting in stable cardiovascular system,slight respiratory depression,definite analgesia effect,and fewer adverse effects.