芬太尼三种配伍方法用于上肢骨科术后PCIA的临床观察

Clinical observation of three kinds of compatible methods of fentanyl for PCIA after upper extremity orthopedic surgery

目的比较芬太尼三种配伍方法用于上肢骨科术后病人自控静脉镇痛(PCIA)的效果及不良反应。方法选择120例ASA Ⅰ～Ⅱ级行上肢骨科切开复位内固定术患者,随机分为三组,每组40例:A组芬太尼0.015 mg/kg;B组芬太尼0.015 mg/kg加氯氨酮2.0 mg/kg;C组芬太尼0.015 mg/kg加氟比洛芬酯100mg。各组均加生理盐水至100 ml,持续输注量2 ml/h。记录术后6、12、24、48 h VAS评分、镇静评分(SS)及不良反应的发生率。结果术后6、12、24,48 h时B、C组的VAS评分低于A组,差异有统计学意义(P<0.05);术后6、12、24、48 h时A组SS略高于B、C组,差异无统计学意义(P>0.05);A组恶心呕吐等并发症发生率显著高于其他两组,差异有统计学意义(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用于上肢骨科术后自控静脉镇痛效果较好,而且术后并发症较少。

Objective To compare anesthetic effect and adverse effects of three kinds of compatible methods patient-controlled intravenous analgesia （PCIA） affter upper extremity orthopedic surgery. Methods One hundred and twenty cases of ASA Ⅰ～Ⅱ grade undergoing upper limb orthopedic surgery with open reduction and internal fix- ation were randomly divided into three groups of 40 cases： A group of fentanyl 0. 015 mg/kg; B group of fentanyl 0. 015 mg/kg plus ketamine 2.0 mg/kg;C group of fentanyl 0. 015 mg/kg plus flurbiprofen ester 100 mg. Normal sa- line in each group were added to 100 ml. The continuous infusion was performecl at 2 ml/h. At 6,12,24,48 h after operation VAS score, sedation score （SS）, and the incidence of adverse reactions were recorded. Results At 6,12, 24,48 h after operation VAS score of B, C group less than the that of A group, the difference was statistically signifi- cant （P 〈0. 05） ; At 6,12,24,48 h after operation SS of A group was slightly higher than the those of B, C group, but the difference was not statistically significant （ P 〉 0.05）. The incidence of complications such as nausea and vomiting of A group was significantly higher than those of the other two groups. The difference was statistically signifi- cant （P 〈 0. 05 ）. Conclusion Small dose of fentanyl adding a small amount of ketamine or a small amount of flurbiprofen ester for PCIA after upper extremity orthopedic surgery have better effects and less postoperative complications.