喷他佐辛用于腰椎间盘突出症患者术后静脉镇痛效果的临床观察

Clinical observation of Pentazocine for postoperative intravenous analgesia in patients with lumbar herniation

目的:观察腰椎间盘突出症患者术后喷他佐辛静脉镇痛的效果和不良反应,以及不同剂量喷他佐辛术后镇痛效果的差异。方法:自2009年1月至2009年12月,对应用喷他佐辛和舒芬太尼的60例行椎板减压、椎弓根内固定的患者进行回顾性分析,其中男34例,女26例;年龄40～65岁,平均59岁;体重60～80kg,平均71kg;按ASA分级为Ⅰ-Ⅱ级。分别用舒芬太尼2g/kg(20例,舒芬太尼组),喷他佐辛3mg/kg(20例,喷他佐辛Ⅰ组)和5mg/kg(20例,喷他佐辛Ⅱ组)加生理盐水至100ml,于手术结束前30min连接静脉镇痛泵,均以2ml/h的速度持续静脉泵输入。记录患者连接止痛泵后4、8、12、24、36、48h的视觉模拟评分(VAS)、Ramsay镇静评分和不良反应。结果:3组患者术后VAS评分均小于3,且3组间差异无统计学意义;喷他佐辛Ⅱ组4、8、12h的镇静评分>4,与舒芬太尼组和喷他佐辛Ⅰ组相比差异有统计学意义;舒芬太尼组恶心、呕吐及皮肤瘙痒发生率高于喷他佐辛Ⅰ组、喷他佐辛Ⅱ组;舒芬太尼组、喷他佐辛Ⅱ组呼吸抑制发生率高于喷他佐辛Ⅰ组,喷他佐辛Ⅱ组头晕发生率高于舒芬太尼组、喷他佐辛Ⅰ组。结论:喷他佐辛用于腰椎间盘突出症患者术后镇痛的效果良好,与舒芬太尼效果相仿,而不良反应发生率低于舒芬太尼。3mg/kg喷他佐辛是术后静脉镇痛治疗较理想的剂量。

Objective：To observe the effects and side effects of Pentazocine for postoperative intravenous analgesia in patients with lumbar herniation,and to investigate the difference of Pentazocine with different doses. Methods：From January 2009 to December 2009,sixty patients undergone laminectomy and pedicle internal fixation,who using equal analgesic dosage of Pentazocine and Sulfentanil,were retrospectively analysed. The patients including 34 males and 26 females,aged 40 to 65 （average 59）,weighted 60 to 80 kg （average 71 kg）,ASA I-II,were divided into Sufentanil group and Pentazocine groupⅠ and Pentazocine groupⅡ,with 20 cases each. The regimens of the three groups included：Sufentanil of 2 g / kg;Pentazocine group Ⅰ of 3 mg / kg; Pentazocine group Ⅱ of 5 mg / kg. All were diluted with saline into 100 ml and were continuously infused at the rate of 2 ml / h. Visual analogue scale （VAS）,Ramsay sedation scale and side effects were recorded at 4,8,12,24,36, and 48 h postoperatively. Results：The three groups had no significant difference in analgesic effects,VAS of all groups were below 3. The sedation scale of Pentazocine group Ⅱat 4,8,12 h was higher than that at 4 h,significantly different than the other two groups. The incidence of nausea,vomiting and pruritus in Sufentanil group were higher than that in the other two groups. The incidence of respiratory depression in Sufentanil group and Pentazocine group Ⅱ were higher than that in Pentazocine group Ⅰ. The incidence of dizziness in Pentazocine group Ⅱ were higher than that in the other two groups. Conclusion：Pentazocine can produce reliable postoperative analgesia for patients with lumbar herniation,as same as the effect of sulfentanil in equal dose. And Pentazocine has fewer adverse effects compared with sufentanil. 3 mg / kg of Pentazocine is an optimal dose for postoperative intravenous patient-control analgesia.