高乌甲素用于老年患者术后镇痛的可行性

Postoperative analgesia with lappaconitine in elderly patients

目的 观察氢溴酸高乌甲素(lappaconitine)应用于老年患者静脉自控镇痛的临床效果与不良反应.方法 40例腹部手术老年患者随机分为两组,L组(n=20)采用氢溴酸高乌甲素,负荷剂量为4 mg,镇痛药液为高乌甲素0.3～0.4 mg/(kg·d)和地塞米松10 mg,用生理盐水配成100 ml;F组(n=20)采用芬太尼,负荷剂量为0.1mg,镇痛药液为芬太尼0.02～0.04 mg/(kg·d)和地塞米松10mg,用生理盐水配成100 ml,维持剂量为2 ml/h持续静脉注药.结果 两组患者用药量差异无统计学意义(P＞0.05),镇痛、镇静评分亦无统计学意义(P＞0.05),总体满意度两组均超过90%,两组24 h不良反应发生率差异无统计学意义,两组患者均无呼吸抑制发生,未见尿潴留.结论 氢溴酸高乌甲素用于老年患者术后静脉自控镇痛安全、有效,不良反应少.

Objective To explore the efiicency and side-effects of patient-controlled intravenous analgesia with lappaconitine in elderly postoperative patients. Methods Fourty elderly 65-68 years old patients scheduled lower abdominal operations were randomly divided into 2 groups. In group L 4 mg lappaconitine was administered as loading dose 10 min before the termination of operations and the sustained doses were 0.3-0.4 mg/（kg-d） lappaconitine mixed with 10 mg dexamethasone in 100 ml normal saline; In group F 0. 1 mg fentanyl were administered as loading dose and the sustained doses were 0.02-0.04 mg/（kg·d） mixed with 10 mg dexamethasone in 100 ml normal saline. Using patient-controlled intravenous analgesia pump, the patient was given continuous infusion at a rate of 2ml/h, the single dose was 0.5ml and lock-out time was 15 min in both groups. Visual analogue scale, sedation scale, total dosage of analgesics, overall satisfaction of pain relief and occurency of side effects were recorded at 4, 8, 12, 24 h after operation. Results There were no significant differences between the two groups in visual analogue scale, sedation scale, the total dosage of analgesics and the occurence of side effects 24 h after operation. The overall satisfaction was more than 90% in both groups. Conclusion Patient-controlled intravenous analgesia with lappaconitine is an effective and safe method with less side effects in postoperative analgesia for eiderly patients.