舒芬太尼与氯诺昔康在开胸手术术后静脉镇痛的临床观察

The Clinical Observation of Patient-controlled Intravenous Analgesia with Sufentanil and Lornoxicam after Thoracotomy

目的：观察舒芬太尼、氯诺昔康＋芬太尼、单用芬太尼在开胸手术术后静脉自控镇痛（PC认）中的镇痛效果及不良反应。方法：90例ASA Ⅰ～Ⅱ级在全麻下行开胸手术术后行PCIA患者随机分为舒芬太尼组（舒芬太尼0．04ve,／kg·h＋地塞米松20mg），氯诺昔康＋芬太尼组（氯诺昔康10μg/kg·h＋芬太尼0．15μg/kg·h＋地塞米松20mg）和芬太尼组（芬太尼0．3μg/kg·h＋地塞米松20mg），3组均加NS后总量至120mL。病人清醒拔管后，接电子镇痛泵，基础流量2mL／h，PCA剂量2mL／次，锁定时间15min。结果：术后16h内三组按键次数及镇痛药消耗总量无统计学意义，氯诺昔康＋芬太尼组和舒芬太尼组不良反应发生率与镇静评分均低于芬太尼组（P〈0．01，P〈0．05），而氯诺昔康＋芬太尼组和舒芬太尼组比无统计学意义；三组各时间点VAS评分比无统计学意义，氯诺昔康＋芬太尼组和舒芬太尼组镇痛总体满意度均高于芬太尼组（P〈0．05）。结论：舒芬太尼与氯诺昔康＋芬太尼或单用芬太尼在开胸手术术后PCIA均可取得满意的镇痛效果，但前两者较后者不良反应少，总体满意度高。更适于开胸术后PCIA。

Objective： To observe the efficacy and adverse reactions of patient-controlled intravenous analgesia（PCIA） with sufentani, lomoxicam ＋fentunyl and fentunyl after thoracotomy. Methods： Ninty ASA Ⅰ～Ⅱ patients undergoing se- lective thoracotomy were randomly assigned into sufentanil group（sufentanil 0.15 μg/kg·h ＋dexamethasone 20 mg ＋NS）, lornoxicam group（lomoxicam 10μg/kg·h ＋fentunyl 0.15 μg/kg·h ＋dexamethasone 20 mg ＋NS）and fentunyl group（fentunyl 0.3 vh ＋dexamethasone 20 mg ＋NS）. PCIA was administered with background infusion 2 mL/h, bolus 2 mL, lockout-time 15 minutes by electronic analgesia pump after extubation consciously. Results： In 16 hours post-operation, there were no significant differences among groups in total number of PCA demand and dosage of drugs, the incidences of adverse reactions and the degree of sedation were lower in the lornoxicam group and sufentani group than those in the fentunyl group（ P 〈 0.01, P 〈 0.05）, but there was no significant difference between lornoxicam group and sufentani group. At all time points, there were no significant differences among groups in VAS scale, but the overall satisfaction of pain relief in the lomoxicam group and sufentani group was higher than that in the fentunyl group （ P 〈 0.05）. Conclusion： Satisfactory analgesic effect gets in PCIA with sufentani, lomoxicam ＋fentunyl and fentunyl after thoracotomy, but the less adverse reactions and the higher overall satisfaction exist in sufentani and lornoxieam ＋fentunyl.