不同剂量瑞芬太尼用于术后PCIA的临床对比研究

A comparison of different dosage of remifentanil in patient-controlled intravenous analgesia for postoperative pain

目的对比观察不同剂量瑞芬太尼(REM)用于术后PCIA效果及不良反应的发生率。方法全身麻醉下择期手术成年患者120例行PCIA,按REM用药剂量不同,随机分成4组(n=30):Ⅰ组0.0033μg/(kg.min)-1,Ⅱ组0.005μg/(kg.min)-1,Ⅲ组0.0067μg/(kg.min)-1,Ⅳ组0.0083μg/(kg.min)-1。于术后6、12、24h各评定一次BP、HR、R、SpO2。镇痛治疗后6h用视觉模拟评分法(VAS)判断患者自诉切口疼痛强度。观察镇痛期间恶心、呕吐、皮肤瘙痒、嗜睡等不良反应及症状程度。结果患者术后6、12、24h BP、HR、R及SpO2与术前比较差异无显著性;Ⅲ组、Ⅳ组与Ⅰ组、Ⅱ组的镇痛效果差异有高度显著性(P均<0.01);Ⅳ组的不良反应发生率与其它三组比较差异有高度显著性(P均<0.01)。结论0.0067μg/(kg.min)-1REM行术后PCIA能取得良好的术后镇痛效果,不良反应发生少,更适合PCIA。

Objective To evaluate the efficacy of different dosage of remifentanil （REM） in patient - controlled intravenous analgesia （PCIA） for postoperative pain and observe the side reactions in order to provide basis of drug election during PCIA. Methods According to different dosage of REM, 120 patients receiving PCIA after elective operation with general anesthesia were randomly allocated to four groups （ n = 30 for each） ： group Ⅰ 0.0033μg/（kg·min）^-1, group Ⅱ 0. 005μg/（kg·min）^-1, group Ⅲ 0. 0067μg/（kg·min）^-1, group Ⅳ 0. 0083μg/（kg· min）^-1. 6h, 12h and 24h after operation, the levels of BP, HR, R and SpO2 were detected for each time. 6 hours after analgesia, the visual analogue scales （VAS） were used to assay the pain degree. Recording adverse reaction such as nausea, vomiting, itch of skin, drowsiness and their degrees. Results 6h, 12h and 24h after operation, BP,HR, R and SpO2 were the same as those before operation, there were no statistical differences. In groups Ⅲ and Ⅳ, the efficacy of analgesia were better than that in groups Ⅰ and Ⅱ, there were statistically significant differences （ P 〈0.01） ; the side reaction occurred in group IV more significantly in comparison to other three groups （ P 〈0.01）. Conclusion REM 0. 0067 μg/（kg·min）^-1 can get better analgesia results for PCIA, and has less side effects as well.