芬太尼透皮贴剂用于术后急性疼痛的临床研究

Clinical Research on Transdermal Fentanyl Used for Postoperative Acute Pain Management

目的:探讨芬太尼透皮贴剂(TDF)用于术后镇痛的可行性、优越性及具体实施方案.方法:60例患者分为3组.均于麻醉前贴TDF 5 mg.T、TM组为硬膜外麻醉下子宫手术,TM组另加椎管内吗啡1.5～2mg;TG组为全麻乳房手术.比较使用TDF前后血浆β-内啡肽、血清泌乳素和皮质醇浓度的变化,并监测HR、RR、SpO2、BP、VAS评分以及副作用的发生.结果:T组的VAS评分在24 h内偏高,24 h后逐渐下降;TM组镇痛效果比T组好,有轻度呼吸抑制;TG组镇痛效果与TM组相似;T组应用TDF 24 h后应激激素浓度升高显著;3组患者副作用的发生无显著性差异.结论:全麻下行乳癌根治术应用TDF 5 mg术后镇痛效果好,未发现严重不良反应.硬膜外麻醉下行子宫切除术应用TDF 5 mg需辅用其它镇痛药以弥补TDF起效缓慢的不足,从而获得良好镇痛效果.

Objective： To research the feasibility, efficacy and method of transdermal fentanyl patch （TDF） in the treatment of postoperative pain. Methods： 60 women were divided into 3 groups. All patients received TDF 5 mg. Group T and TM received abdominal hysterectomy and epidural anesthesia. Group TM received morphine 1.5- 2 rng besides. Group TG received breast cancer resection and general anesthesia. The changes of plasma β- endorphin, serum prolactin and cortisol before and after patch application were analyzed. Heart rate, respiratory rate, SpO2, blood pressure, pain score （VAS）, and adverse reactions were monitored at prescribed intervals. Results： VAS pain score was higher in group T at first 24 h after patch application, and gradually down at 24 h after patch application. The analgesia effect was better in group TM than in group T, but more respiratory depression may occur. Group TG and TM had similar analgesia. The concentrations of stress hormone were significantly higher in group T at 24 h after patch application. There was no significant difference in the incidence of adverse effects in all 3 groups. Conclusion： Breast cancer reaction can apply TDF 5 mg for postoperative analgesia alone. The analgesia effect was good and safe. If TDF 5 mg is used for hysterectomy postoperative analgesia, the patients need to be assisted by other analgesics until plasma fentanyl concentration reaches a peak level,thereby the analgesia effect can be better.