舒芬太尼与哌替啶用于开胸食管癌切除术后患者静脉自控镇痛比较

Comparison of PCIA after Sulfentany and Meperidine in esophagus cancer resection operation

目的观察等效剂量哌替啶与舒芬太尼应用于开胸食管癌切除术后患者静脉自控镇痛(PCIA)效果和不良反应。方法选择期全麻下行开胸食管癌切除手术后的患者56例,随机分为P组(28例)和S组(28例)。手术结束后,在患者吞咽、咳嗽反射恢复,完全清醒拔管后用镇痛泵行PCIA,P组的药物配方为哌替啶25.8mg/kg+NS 300ml;S组为舒芬太尼4.3ug/kg+NS 300ml。背景剂量为4ml/h,患者自控镇痛泵单次给药剂量0.5ml,锁定时间为15min。分别记录术后2h、8h、16h、24h、48h、72h静息状态下和咳嗽或运动时疼痛视觉模拟(VAS)评分以及镇静评分,记录在镇痛72h内患者对镇痛效果的满意度,记录SPO2、BP、HR、RR以及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生情况。结果两组病人静息状态下和咳嗽或运动时的视觉模拟评分在2h、8h、16h、24h、48h、72h时无显著差异,效果满意。镇痛过程中两组均无呼吸抑制发生,恶心、呕吐、皮肤瘙痒P组显著高于S组(P<0.05)。结论与等效剂量的哌替啶相比,舒芬太尼应用于开胸食管癌切除术后患者PCIA的镇痛作用完善、确切,而恶心、呕吐、皮肤瘙痒等不良反应的发生率显著低于哌替啶。

Objective To observe the anagesia effect and untoward reaction of PICA after sulfentany and meperidine in esophagus cancer resection operation. Methods 56 patients underwent esophagus cancer resection operation with general anesthesia were randomly divided into two groupMgroup P and group S, each of them having 28 people ）. When the patients recover the swallow, coughing1 reflex and total awake extubation after post procedure1 Analgesia Mercury PICA were applied upon the patients. The effect and side--effect were observed. Results There was no marked difference on the VAS grade between the two groups when they were in the resting situation and the condition of coughing or doing exercise after post procedure 2h 8h 16h 48h 72h. The effect was perfect. During the process of analgesia, none of them occur the respiratory depress. The situation of the nausea, vomiting and itch of skin of group P were more serious than that of group S （P〈0.05）. Conclusion Compared with ED meperidine, sulfentany used in esophaged cancer resection operation is more exact and precise.