舒芬太尼联合地佐辛用于老年患者下肢关节置换术后静脉镇痛的临床观察

Effects of postoperative intravenous analgesia with dezocine and sufentanil on elderly patients after arthroplasty

目的观察老年患者下肢关节置换手术后舒芬太尼联合地佐辛静脉镇痛的疗效与安全性.方法选择60例ASA分级Ⅱ~Ⅲ级择期行膝髋关节置换术的老年(年龄≥65岁)患者,按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,镇痛泵配方分别为舒芬太尼+氟哌利多、舒芬太尼+地佐辛+氟哌利多、舒芬太尼+氟哌利多(联合地佐辛肌肉注射).各组镇痛泵的背景输注量2ml/h,视觉模拟评分(VAS)>5肌肉注射哌替定75 mg.观察各组术后6、12、24 h VSA评分、Ramsay评分、不良反应发生率及术后额外镇痛药用量.结果三种配方均能为患者提供良好的术后镇痛.Ⅱ组的VSA评分和不良反应发生率优于Ⅰ、Ⅲ组,Ⅲ组术后6 h Ramsay评分明显高于Ⅰ组和Ⅱ组(P<0.05),术后需额外镇痛患者数也明显多于其他两组(P<0.05).结论舒芬太尼联合地佐辛用于老年患者膝髋关节置换术后镇痛可提高术后镇痛质量,减少阿片类药物的用量,减少术后不良反应的发生率,值得临床应用.

Objective To evaluate the effects of intravenous analgesia with dezocine combining sufentanil in hip and knee arthroplasty for elderly patients.Methods Ninety patients with ASA Ⅱ~Ⅲ and aged≥65 years who were scheduled for hip and knee arthroplasty under CSEA and treated with intravenous analgesia post-operation were selected and divided into three group(20 cases):groupⅠ(sufentanil 2.5μg/kg+droperidol 2.5 mg),groupⅡ(sufentanil 2.0μg/kg+dezocine 10 mg+droperidol 2.5 mg)and group Ⅲ(intramuscular dezocine 10 mg and sufentanil 2.0μg/kg+droperidol 2.5 mg),which were diluted to be 100 ml by adding saline.VSA,Ramsay score as well as side effects were recorded at 6,12 and 24 h after operation.75 mg meperidine was administered intramuscularly as rescue medication when VAS was above 5.Results Compared with group Ⅰ and Ⅲ,group Ⅱ showed better outcomes regarding to the VAS and less side effects.Ramsay score 6 h after operation and the amount of patients who needed meperidine in groupⅢwere higher than those in the other two groups(P<0.05).Conclusion Dezocine combining with sufentanil in elderly patients underwent low limb arthroplasty shows better postoperative analgesia effects with less side effects,and it's worth for clinical application.