OSAS患者UPPP术后自控镇痛的临床观察

The Clinical Observation on the Patient-controlled Analgesia for OSAS Patients Postoperation of UPPP

目的通过病人自控镇痛(PCA)的方法,用曲马多和芬太尼控制阻塞性睡眠呼吸暂停综合征(OSAS)患者行悬雍垂腭咽成型术(UPPP)后出现的严重疼痛。方法成年男性患者42例,用数字表法随机分为2组:曲马多组(24人)和芬太尼组(18人)。术后分别对病人应用芬太尼或曲马多进行自控镇痛。并于术后6 h、次日晨、术后24 h和48 h定时随访,观察患者静息和吞咽时的镇痛评分(VAS)、患者自行按压PAC泵累计次数、总用药量、术后24 h镇静评分及恶心、呕吐、头晕等症状出现的情况。结果2组患者术后不同时间点静息及吞咽的VAS评分比较差异无统计学意义(P>0.05)。曲马多组术后24 h和48 h的PCA泵累计按压次数明显少于芬太尼组,差异有统计学意义(P<0.05)。术后48 h静脉镇痛使用的总药量,曲马多组为(593.56±198.71)mg,芬太尼组为(864.58±402.9)μg。术后24 h镇静评分结果为:曲马多组中0级患者占75%,芬太尼组占44.4%。2组中恶心、呕吐、头晕的发生率差异均无统计学意义(P>0.05)。结论PCA是睡眠呼吸暂停综合征患者UPPP术后较理想的镇痛方法,应用曲马多和芬太尼均可取得较好的镇痛效果。

Objective There was severe pain after the operation of uvulopalatopharyngoplasty （UPPP） for the patients suffered from obstructive sleep apnea syndrome （OSAS）. It was necessary to give the analgesia for those patients. The patientcontrolled analgesia （PCA） was performed with tramadol or fentanyl for those patients. Methods 42 adult male patients were divided into two groups, tramadol （24） or fentanyl （18） group randomly. The pain score （VAS） of those patients at rest and swallow were observed at the time points as follows： the time of 6 h, the next morning, 24 h and 48 h after the operation. The total press number, the total amount of drug on PCA modal, the sedation score during the 24 h postoperative, the PONV and dizziness were also recorded. Results The pain score at both rest and swallow state had no difference at different times after the operation between the two groups. The total numbers of press in tramadol group were significant less than those in fentanyl group at the time of 24 h and 48 h after the operation. The total amount of drug is （593.56±198.71）mg in tramadol group,while that in fentanyl group is （864.58±402.9）μg. At the time of 24 h after the operation, the number of patients whose Ramsey score is zero, in tramadol group is 75% ,while that in fentanyl group is 44.4%. There is no difference between the two groups in PONV and dizziness. Conclusion PCA is a good method for the OSAS patients postoperation of the UPPP in terms of pain relieving. The analgesia with tramadol and fentanyl can both gain satisfied effects.