不同配伍芬太尼术后硬膜外病人自控镇痛效应的比较

A randomized double blind comparison of efficacy of patient controlled epidural analgesia with combinations of fentanyl and other drugs for postoperative pain

目的：采用硬膜外病人自控镇痛（ＰＣＥＡ）技术，对不同配伍芬太尼术后镇痛效应进行了研究。方法：１００例（ＡＳＡⅠ～Ⅱ级）手术病例随机分成三组，Ｆ组（ｎ＝２０）：用０．０００４％芬太尼＋０．１５％丁哌卡因；ＢＦ组（ｎ＝４０）：用Ｆ组药液＋０．０００９％丁丙诺啡；ＭＦ组（ｎ＝４０）：用Ｆ组药液＋０．００５％吗啡；采用双盲法对比观察。结果：术后２４小时三组病人ＶＡＳ评级Ｆ组最高（Ｐ＜０．０５），ＰＣＥＡ总按数／实进数（Ｄ／Ｄ）比值在０～２范围内的病例数，ＭＦ组≈ＢＦ组＞Ｆ组（Ｐ＜０．０５），提示ＭＦ、ＢＦ组镇痛效果较好。三组病人ＰＣＥＡ期间呼吸、循环无明显变化，恶心、呕吐等并发症较低（２．５％～５．０％），后两组有１０％～１５％病人嗜睡。结论：选择芬太尼和丁哌卡因行ＰＣＥＡ时，复合小剂量吗啡（０．００５％）或丁丙诺啡（０．０００９％）其镇痛效果更好。

Objective:To compare the efficacy of patient controlled epidural analgesia (PCEA) of combinations of fentanyl and other drugs for postoperative analgesia Method:One hundred patients (ASA status Ⅰ or Ⅱ) undergoing surgery with epidural anesthesia were randomly assigned to three groups,group F:0 0004% fentanyl with 0 15%bupivacaine,group BF:0 0004% fentanyl+0 15% bupivacaine+0 0009% buprenorphine,and group MF:0 0004% fentanyl+0 15% bupivacaine+0 005% morphine for PCEA All patients received epidural bolus of 5 ml solution above mentioned followed by epidural infusion at 1ml·h -1 PCA dose(1ml) was administered as required by the patients for supplemental analgesia with 20 minutes lockout period and total dose in 1 hour was limited at 9ml Result:The total dose of group F was larger than that of groups BF and MF in first operative 24h,there was a signifcant lower VAS score in groups BF and MF,the patients with PCA demand to delivery ratio(D/D ratio) between 0 and 2 were more in groups BF and MF than those of group F There were no signifcant changes of circulation and respiration in three groups The incidence of nausea and vomiting was between 2 5% and 5% in three groups and mild somnolance was about 10% to 15% in group BF and MF Conclusion:PCEA is safe and effective analgeaia method Adding low dose morphine (0 005%) or buprenorphine(0 0009%) to fentanyl plus bupivacaine solution for PCEA may enhance greatly the efficacy of postoperative pain relief