鼻及鼻窦手术后的镇痛

Clinical study on postoperative analgesia following sinonasal surgery

目的观察双氯灭痛栓剂(diclofenacsuppo-sitory,DS)塞肛、芬太尼针加氟哌利多针微泵静脉注射维持患者自控镇痛(patientcontrolledanalgesia,PCA)(简称芬氟合剂PCA)、颅痛定肌肉注射用于鼻及鼻窦手术后镇痛的疗效。方法对1998～2004年鼻及鼻窦手术后178例患者进行镇痛对比研究,DS塞肛组(D组)82例,芬氟合剂PCA组(F组)36例、颅痛定肌肉注射组(T组)60例,统计学分析术后镇痛疼痛、恶心、呕吐和镇静等评分及镇痛处理的费用情况。结果三组患者的VAS评分:术后镇痛D组和F组无明显差别(P>0.05),均低于T组,且差异均有显著意义(P<0.01);D组和T组患者恶心、呕吐的发生率明显低于F组,D组和T组无一例患者需要抗呕吐药物治疗,F组中有9例(25%)需给予胃复安;F组患者(5/36)嗜睡的发生率明显高于D组(1/82)和T组(5/60),差异均有显著意义(P<0.01和P<0.05);D组费用明显低于F组。结论DS塞肛和芬氟合剂PCA具有同样镇痛效果,DS塞肛不良反应轻,费用低廉,应用方便,患者易于接受,是一种有价值的鼻及鼻窦手术后镇痛方法。

OBJECTIVE To compare the clinical efficacy and side effects of diclofenac suppository（DS）,fentanyl / droperidol mixture for postoperative patient controlled analgesia（PCA）and Rotundine after sinonasal surgery. METHODS One hundred and seventy-eight patients were allocated into three groups： DS of 82 patients （D group）, the mixture of fentanyl and droperidol for postoperative patient controlled analgesia（PCA）of 36 patients（F group）and Rutondine of 36 patients （T group）. The VAS, analgesic doses,and side effects were observed 2,6,24 and 48 hours after operation respectively. RESULTS VAS score： no significant differences were found between group D and group F（P〉0.05）, though scores of both group were signiflcantiy lower than that of group T（P〈0.01）. The nausea rates and vomiting rates at any time point in the group D and group T were all significantly lower than those in the group F（P〈0. 05）. Nine cases in the group F needed treatment of metoclopramide, and none of patients in the group D and group T needed antiemetic（P〈 0.01）; Patients in group F were more sleepy than group D（P〈0.01）and group T（P〈 0.05）, while expenditure of group D was lower than that of group F. CONCLUSION Providing similar analgesia, DS was superior to PCA with less adverse side effects. DS is a satisfactory and simple method and cheap for controlling postoperative pain.