芬太尼不同配伍方法用于骨科术后静脉镇痛的研究

CILNICAL EVALUATION OF FENTANYL COMBINED WITH OTHER DRUGS OR SINGLE USED IN PCIA AFTER OSTEO-OPERATIONS

目的观察芬太尼复合应用及单独用于术后病人自控静脉镇痛(PCIA)的效果及不良反应。方法选择60例ASAⅠ或Ⅱ级行上肢骨科切开复位内固定术患者,随机均分为四组:A组,芬太尼0.02mg/kg;B组,芬太尼0.015mg/kg;C组,芬太尼0.015mg/kg加氯氨酮2.0mg/kg;D组,芬太尼0.015mg/kg加氟比洛芬酯100mg。各组均加生理盐水至100ml,持续输注量2ml/h。记录术后6、12、24、48h VAS评分、镇静评分、及不良反应的发生率。结果术后6、12、24,48h时A、C、D组的VAS显著低于B、组(p<0.05);术后6、12h时A组SS高于其他三组(p<0.05),12h后四组间的SS差异无统计学差异。A组恶心、呕吐的发生率显著高于其他三组(p<0.05)。结论小剂量芬太尼加入少量氯氨酮或者加入少量氟比洛芬酯静脉镇痛效果较好,且不良反应较少。

Objective To observe the effect and adverse reactions of intravenous analgesia（PCIA） with fentanyl and ketamine or flurbiprofen axetil on the side effects accompanied by PCIA with different doses of pure fentanyl. Methods 60 adult patients, ASA I - II, were randomly divided into four groups ： （0. 02 mg/kg fentanyl）/100 ml, （ 0. 015 mg/kg fentanyl）/100 ml, （0.015 mg/kg fentanyl ＋ 2.0 mg/kg ketamine）/100 ml, （0. 015 mg/kg fentanyl ＋ 100mg flurbiprofen axetil）/100ml was used in group A, B, C or D respectively. VAS, SS were recorded at the time points of 6,12,24 and 48h after operation. The incidence of adverse effects were recorded in 48 h after surgery. Results VAS in group B was significantly higher than that of other groups at all four time points （p 〈 0.05 ） ; SS in group A was the highest in all groups at the time points of 6h and 12 h（p 〈0.05） after operation. The incidence of nausea and vomiting in group A was obviously higher than that of other groups postoperatively （p 〈 0. 05 ）. Conclusion PCIA with proper dose of ketamine or flurbiprofen axetil together with small dose of fentanyl could provide better postoperative analgesia, and reduce the adverse effect.