吗啡和芬太尼用于上腹部手术后镇痛的比较

Comparison of analgesia with morphine and fentanyl after upper abdominal surgery

目的比较吗啡、芬太尼用于病人自控硬膜外镇痛(PCEA)的镇痛效果及不良反应.方法60例择期手术患者,ASA Ⅰ～Ⅱ级,随机分为两组,每组30例.A组选用0.01%吗啡+0.005%氟哌利多+0.01%地塞米松+0.075%丁卡因;B组选用0.004%芬太尼代替A组配方中的0.01%吗啡.均用PCA泵(100ml),以LCP模式(负荷剂量5ml+持续剂量2ml/h+PCA每次0.5ml)进行镇痛.结果①综合镇痛质量,A组与B组无明显差异(P＞0.05);②A组恶心、呕吐、尿潴留、嗜睡等发生率较B组高(P＜0.01或P＜0.05).结论吗啡、芬太尼PCE用于术后镇痛均可取得满意效果,但芬太尼较吗啡的不良反应少,更适合术后镇痛.

Objective To compare the clinical effects and adverse effects of morphine and fentanyl with a patient - controlled epidural analgesia （PCEA） delivery system. Methods ASA Ⅰ-Ⅱ 60 patients undergoing upper abdominal operations were randomly divided into two groups with 30 cases respectively. Group A was given 0.01% morphine ＋ 0. 005% droperidol ＋ 0. 01% dexamethasone ＋ 0.075% tetracaine;In group B 0. 0004% fentanyl was given to substitute 0.01% morphine in group A. All patients received PCA（total volume 100ml） and devised in LCP Model（ load dose 5ml ＋ continuous infusion 2ml/h ＋ PCA Bolus 0. 5ml） after operation. MAP, HR, RR, visual analogue scale （VAS）, rmaesay sedation scale （RSS） of 4,8,12,24,36,48h were recorded. Results There were no significantly differences between the two groups in the analgesia （ P 〉 0.05 ） ; The incidences of nausea, vomiting, uroschesis and somnolence in group A were higher than that in group B（ P 〈 0.01 or P 〈 0.05 ）. Conclusion When used in postoperative PCEA, morphine and fentanyl can provide same satisfied effect. However, the adverse effects of fentanyl were lower than those of morphine. Fentanyl is more suitable for postoperative analgesia.