地佐辛和舒芬太尼用于妇科手术后静脉自控镇痛

Combination of sufentanil and dezocine in patient-controlled analgesia after gynaecologic surgery

目的探讨地佐辛复合舒芬太尼用于妇科手术静脉自控镇痛的安全性和可行性。方法选择择期全麻下妇科手术患者120例,年龄18～65岁,ASAⅠ～Ⅱ级,随机分为3组,每组40例:S组,舒芬太尼150μg加0.9%氯化钠溶液至100ml;SD组,地佐辛10mg加舒芬太尼100μg加0.9%氯化钠溶液至100ml;D组,地佐辛10mg加0.9%氯化钠溶液至100ml。分别于术后4h、8h、24h、48h记录镇痛、镇静评分及PCA泵有效/实际按压次数比,并观察术后恶心、呕吐、皮肤瘙痒及呼吸抑制等并发症的发生情况。结果 S组和SD组术后48h内的VAS评分明显低于D组(P<0.01);在4～24h内,S组的镇静评分明显高于SD组和D组(P<0.01);在4～24h内,S组和SD组PCA泵有效/实际按压次数比明显高于D组(P<0.05)。对于3组患者术后恶心、呕吐、皮肤瘙痒及呼吸抑制等不良反应的发生,3组之间的差异无统计学意义(P>0.05)。结论地佐辛复合舒芬太尼用于妇科手术后静脉自控镇痛的镇痛效果优于单用地佐辛,较单用舒芬太尼,可降低术后嗜睡的发生,是一种安全可行的镇痛方法。

Objective To observe the security and feasibility of combination of dezocine and sufentanil in patient - controlled analgesia after gynaecologic surgery. Methods One - hundred and twenty patients aged between 18 and 65 years old with an ASA physical status I or II undergoing gynaecologic surgery were randomly divided into three groups： sufentanil 150μg in S group; Dezocine 10mg and sufentanil 100μg in SD group;Dezocine 10mg in D group. Each drug was diluted to 100ml and infused by a pump at a rate of 2ml/h with a patient - controlled bolus of 0.5ml after a loading dose of fentanil 1 μg/kg. The visual analog scale, score of sedation, drug consumption and incidence of side effects were recorded at 4, 8, 24 and 48 h after operation by the investigators. Results The VAS values of group S and group SD within 48 hours were significantly lower than those of group D ; Between 4 and 24 hours the scores of sedation of group S was significantly higher than those of group SD and group D; The incidence of nausea, vomiting, pruritus and respiratory depression were not significantly different between three groups. Conclusion Combinations of dezocine and sufentanil in PCA ean attain better analgesia compared to dezocine and decrease the incidence of drowsiness compared to sufentanil. This may provide a novel combination strategy of opioid agonist and agonist - antagonist for postoperative pain management after gynaecologic surgery.