舒芬太尼和高乌甲素用于患者自控静脉镇痛的观察

Patient controlled intravenous analgesia with sufentanil or lappaconitine

目的观察舒芬太尼或氢溴酸高乌甲素配伍芬太尼用于术后患者自控静脉镇痛(PCIA)的镇痛效果及不良反应。方法选择80例ASAⅠ～Ⅱ级的择期手术患者,随机分为两组:舒芬太尼组(S组)(n=40),舒芬太尼0．1 mg+芬太尼0．6～1．0 mg+氟哌利多2．5～5 mg+地塞米松5～10 mg;高乌甲素组(L组)(n=40),氢溴酸高乌甲素16 mg+芬太尼0．6～1．0 mg+氟哌利多2．5～5 mg+地塞米松5～10 mg。两组均以生理盐水稀释到100 ml,按2．0 ml／h静脉持续镇痛,负荷剂量为相同配伍药液5～10 ml。术后监测生命体征,记录术后36 h内镇痛、镇静效果、不良反应及肠蠕动恢复情况。结果两组均可提供较好的术后镇痛,在术后的36 h内VAS评分两组的镇痛效果差异无统计学意义(P>0．05)。两组肠蠕动恢复时间差异无统计学意义(P>0．05)。两组均未发现恶心呕吐,仅舒芬太尼组出现瘙痒2例,但两组之间差异无统计学意义(P>0．05)。结论舒芬太尼或氢溴酸高乌甲素配伍芬太尼均可提供良好的术后镇痛、镇静,不影响术后肠蠕动功能恢复,且不良反应较少。舒芬太尼组在术后8 h时段镇痛、镇静效果略优于氢溴酸高乌甲素组。

Objective To investigate the patient-controlled analgesic effects and side effects of sufentanil or lappaconitine combined with fentanyl. Methods Eighty patients ASA Ⅰ-Ⅱaged 18-78 years, weighing 50-90 kg were randomly allocated into two groups. In group Ⅰ （ n = 40） patients received fentanyl 0.6-1.0 mg/48 h combined with sufentanil 100 μg/48 h;in group Ⅱ（n =40） patients received fentanyl 0. 6-1.0 mg/48 h combined with lappaconitine 16 mg/48 h. Droperidol 2.5-5 mg and dexamethasone 5-10 mg were added into the analgesic solution that was diluted to 100 ml with normal saline in both groups. Postoperative pain, enterocinesia recovery time and side effects such as pruritus, sedation, nausea and vomiting were recorded at postoperative times 4,8,12,2g and 36 h. Postoperative pain was rated on a visual analogue scale （VAS） and absolute VAS≤3 was considered as an analgesic success. Results VAS were significantly decreased in both groups and there were no statistical differences in the incidence of side effects and enterocinesia recovery time in two groups. Conclusions Sufentanil or lappaconitine combined with fentanyl can provide satisfactory postoperative analgesia with few side effects and sufentanil is better than lappaconitine in the period of first 8 hours postoperative analgesia.