择期神经外科手术术后镇痛及不良反应的回顾性研究

A retrospective study of analgesia efficacy and its side effect in 127 patients undergoing selective neurosurgery

目的探讨颅内肿瘤切除术患者术后镇痛状况及年龄等因素对镇痛效果的影响。方法回顾127例颅内肿瘤切除术后患者麻醉镇痛(芬太尼联合昂丹司琼静脉持续镇痛)过程,根据视觉模拟评分(VAS)、Ramsay评分和静脉镇痛是否影响患者下床活动等标准,评价手术前和手术后24 h、48 h之心率、平均动脉压、呼吸频率,以及手术后24和48 h疼痛程度、精神状态、活动状态和术后不良反应(呕吐、皮肤瘙痒、尿潴留、排气障碍)发生情况。结果不同年龄组患者平均动脉压和呼吸频率差异有统计学意义(均P=0.000),但仍在正常值范围。术后总体镇痛优良率为84.25%(107/127)。不同年龄组同一测量时间点静息和活动时VAS评分差异无统计学意义(均P>0.05),但各组手术后48 h VAS评分均低于24 h时(均P=0.000)。术后总体呕吐发生率为29.13%(37/127),尿潴留发生率为14.96%(19/127),各年龄组之间差异均无统计学意义(P>0.05)。影响因素分析,性别与手术后呕吐有关(P=0.022),而美国麻醉医师协会(ASA)分级、年龄与手术后精神状态、活动状态呈正相关(P<0.05)。结论芬太尼联合昂丹司琼持续静脉镇痛仍可为颅内肿瘤切除术患者提供较好的术后镇痛效果。性别可能为术后发生恶心、呕吐高危因素,而手术后精神状态和活动状态主要与患者年龄、ASA分级有关。

Objective To investigate the analgesia efficacy and selective cranieetomy, and to study risk factors of analgesia side effects. patients undergoing selective Department of Anesthesiology, the impact of age on it after Methods One hundred and twenty-seven patients undergoing selective craniectomy were enrolled in this study. All patients were administered with fentanyl and ondansetron to produce continuous intravenous postoperative analgesia. Patients were evaluated by Visual Analog Score （VAS）, Ramsay score and the impact on their mobility status. Heart rate （HR）, mean blood pressure （MBP） and respiratory rate （RR） were recorded at preoperative time, and 24 h and 48 h after operation. We mainly focused on the incidence of postoperative pain and side effects of analgesia （such as nausea and vomiting, urinary retention, pruritus and exhaust time）. Results There were statistic differences in MBP and RR among 3 groups （P = 0.000, for all）, but all within normal range. Total rate of excellent analgesia was 84.25% （107/127）, and there was no statistic difference in VAS among 3 groups （P 〉 0.05, for all）. The VAS （at rest and mobility status） at 48 h was significantly lower than at 24 h after surgery （P = 0.000, for all）. Total incidence of postoperative nausea and vomiting （PONV） was 29.13% （37/127）, and total incidence of urinary retention was 14.96% （19/127）. There was no statistic difference in the incidence of PONV and urinary retention among 3 groups （P 〉 0.05, for all）. The risk factor of PONV was gender （P = 0.022）. American Society of Anesthesiologists （ASA） score was related to mental state （r, = 0.202, P = 0.023） and mobility status （rs = 0.221, P = 0.013）. Age was related to mental state （rs = 0.945, P = 0.015） and mobility status （rs = 0.940, P = 0.020）. ASA score also had a correlation with pruritus （rs = 0.212, P = 0.017）. Conclusion Fentanyl combined with ondansetron can produce a good eontinuous intravenous postoperative analgesia for patients undergoing craniectomy. The risk factor of PONV is gender. Mental state and mobility status are related to ASA score and age.