瑞芬太尼和芬太尼用于开胸术后病人自控静脉镇痛的比较

Clinical Study of Patient-controlled Intravenous Analgesia with Remifentanil or Fentanyl in Thoracic Postoperative Patients

目的：观察比较等效剂量瑞芬太尼和芬太尼用于开胸术后病人自控静脉镇痛（Patient-controlled intravenous anagesia，PCIA）的镇痛效果及其不良反应。方法：选择ASAⅠ～Ⅱ级、年龄40～60岁择期全麻下行开胸手术患者40例，随机分为芬太尼组（F组）和瑞芬太尼组（R组），每组20例。全麻诱导后双腔管气管内插管，术中异氟烷吸入维持全麻，罗库溴铵维持肌松。病人清醒拔管后接韩国奥美2300电子镇痛泵行PCIA。F组：芬太尼2mg＋咪唑安定10mg＋生理盐水至200ml；R组：瑞芬太尼0．2mg＋咪唑安定10mg＋生理盐水至200ml。背景剂量2．0ml／h，指令剂量2．0ml／次，锁定时间15min。所有术后病人鼻导管吸氧2～31／min，分别记录术后24h、48h的疼痛（视觉模拟评分VAS法）、镇静、恶心和呕吐评分，记录脉搏氧饱和度（SpO2）、心率（HR）、呼吸频率（RR）、平均动脉压（MAP）和累计镇痛药消耗量（CAC）。结果：R组术后24h、48h镇痛药耗量和VAS评分均低于F组，其中术后48hVAS评分有显著性差异（P〈0．05）；R组术后24h、48h镇静评分达2分者明显多于F组，其中术后24h两组有显著性差异（P〈0、05）；两组术后48h呕吐者和静息时感恶心者无显著差异（P〉0．05）；两组术后48h内无l例呼吸抑制（Sp02持续低于90％者）发生。两组术后24h、48h脉搏氧饱和度、心率、呼吸频率和平均动脉压均无显著差异。结论：等效剂量的瑞芬太尼用于开胸术后PCIA，镇痛、镇静效果优于芬太尼，而恶心、呕吐及呼吸抑制发生率低，是开胸术后更为安全、有效的镇痛方法。

Objective： To observe clinical efficacy of equivaent dose of remifentanil or fentanyl for patient controlled intravenous analgesia（ PCIA ） in thoracic postoperative patients. Methods： Forty AS.A Ⅰ～Ⅱ patients（40 -60 years） undergoing radical operation of lung or esophageal cancer were randomly divided into two group,the remifentanil intravenous analgesia groups （ group R, remifentanil 10 ug/ml） and intravenous analgesia group （group F, fentanyl 10 ug/ml）. The PCIA device was set at backgrond fentanyl infusion2.0 ml/h , bolus 2.0ml and lockout time 15minutes. The pain intensity （VAS）, cumulative analgesic con- sumption（CAC）, sedative scores and side effects at 24 , 48h after administration were recorded. SpO2, RR, BP and ECG were continuously monitored. Results： There were no significant differences of CAC between two groups, however the VAS in group R was lower than that in group F （P 〈 0.05 ） and sedative efficacy of group R was superior than that of group F （ P 〈 0.05 ）. There were no significant differences of nausea and vomiting between two groups （ P 〉0.05 ）. There were no significant differences of SpO2, RR, HR and MAP between two groups. Conclusion： PCIA with remifentanil can provide better efficacy of anagesia and sedation than with fentanyl, and lower incidence of nausea , vomiting and respiratory depression in thoracic postoper- ative patients.