地佐辛及氟比洛芬酯多模式镇痛对食管癌患者术后镇痛效果的比较研究

目的 比较地佐辛和氟比洛芬酯多模式镇痛对食管癌患者术后镇痛的效果,探讨超前镇痛及术后经静脉患者自控镇痛（PCIA）用于大型手术术后镇痛的可行性.方法 选取择期行食管癌根治术患者60例,美国麻醉师协会（ASA）Ⅰ或Ⅱ级,采用随机数字表法将患者分为地佐辛组（30例）和氟比洛芬酯组（30例）.地佐辛组于麻醉前5 min静脉推注地佐辛0.1 mg/kg;氟比洛芬酯组于麻醉前5 min静脉推注氟比洛芬酯1 mg/kg.2组患者术中靶控输注丙泊酚、瑞芬太尼,间断给予顺阿曲库铵麻醉维持.术后均行经静脉PCIA,地佐辛组镇痛药配方为地佐辛30 mg＋芬太尼0.5 mg,氟比洛芬酯组为氟比洛芬酯200 mg＋芬太尼0.5 mg,均加入托烷司琼6 mg,用0.9％氯化钠注射液稀释至100 ml,初始负荷剂量2 ml,背景剂量2 ml/h,单次PCIA剂量为1.5 ml,锁定时间15 min.观察并记录患者术后1、3、6、12、24 h的疼痛视觉模拟量评分、Prince-Henry疼痛评分、Ramsay镇静评分、48 h内PCIA按压次数和不良反应发生情况.结果 在术后6、12、24 h时间点,地佐辛组Ramsay镇静评分明显高于氟比洛芬酯组,差异有统计学意义[6 h：（3.5±0.6）分比（2.2±0.4）分,12 h：（2.5±0.5）分比（2.1±0.3）分,24 h：（2.2±0.3）分比（2.0±0.4）分,P＜0.05];术后48 h内氟比洛芬酯组PCIA按压次数明显多于地佐辛组,差异有统计学意义[（12.1±1.3）次比（10.8±1.8）次,P ＜0.05];2组患者均未出现呼吸抑制和异常出血,氟比洛芬酯组患者眩晕、恶心和呕吐发生率明显高于地佐辛组,差异有统计学意义[眩晕：13.3％ （4/30）比10.0％ （3/30）,恶心：20.0％ （6/30）比13.3％ （4/30）,呕吐：10.0％ （3/30）比6.7％（2/30）,P＜0.05].结论 地佐辛和氟比洛芬酯多模式镇痛对食管癌患者术后镇痛的效果确切有效,但与氟比洛芬酯相比较,地佐辛不仅能为患者提供良好的镇静,还能减少术后不良反应的发?

Effect of multimodal analgesia of dezocine versus flurbiprofen in patients undergoing esophageal caner surgery

Objective To compare the effect of multimodal analgesia between dezocine and flurbiprofen axetil which were used in patients undergoing esophageal caner surgery; to investigate the feasibility of preemptive and postoperative patient-controlled intravenous analgesia （PCIA） in major surgeries.Methods Sixty patients with Americam Society of Anesthesiologists Ⅰ-Ⅱ class and undergoing esophageal caner surgery were randomly divided into dezocine group（n =30） and flurbiprofen axetil group（n =30）.The single intravnous injection dezocine （0.1 mg/kg） and flurbiprofen axetil 1 mg/kg were given 5 min before anesthesia started.Anesthesia of both group patients was induced with target controlled infusion of propofol,remifentanyland intermittent cisatracurium.All patients of two groups received PCIA pump after operation according to different PCIA formula：flurbiprofen axetil group received fentanyl 0.5 mg plus dezocine 30 mg; flurbiprofen axetil group received fentanyl 0.5 mg plus flurbiprofen axetil 200 mg; tropisetron 60 mg was also added identicanlly in two groups; total PCIA volume was 100 ml saline with loading volume 2 ml,background volume 2 ml/h,bolus dose 1.5 ml and lockout time was 15 min.The visual analogue scale/score,Prince-henry and Ramsay sedation scale were recorded 1,3,6,12,24 h after surgery.Total PCIA pressing times and the adverse effects were also recorded.Results At 6,12,24 h,compared with those in flurbiprofen axetil group,the scores of Ramsay in dezocine group were significantly increased [6 h：（3.5 ±0.6）scores vs （2.2 ±0.4）scores,12 h：（2.5 ±0.5）scores vs （2.1 ±0.3）scores,24 h：（2.2 ±0.3）scores vs （2.0 ± 0.4） scores,all P 〈 0.05].Compared with those in flurbiprofen axetil group,the total PCIA pressing times in dezocine group were significantly decreased[（10.8 ± 1.8） times vs （12.1 ± 1.3） times,P 〈 0.05].All patients had no respiratory depression and abnormal bleeding.Compared with dezocine group,the incidence of adverse reaction in 48 h