瑞芬太尼对上腹部手术后静脉自控镇痛效果及安全性

Effectiveness and safety of PCIA with remifentanil in the patients with upper abdominal surgery

目的:观察瑞芬太尼用于上腹部手术后患者静脉自控镇痛效果及安全性。方法:2008年10月-2010年10月本院择期行腹腔手术患者160例随机分为瑞芬太尼组和芬太尼组。瑞芬太尼和芬太尼的剂量均为0.02 mg.kg-1,均用生理盐水稀释至100 mL。2组患者术后行自控镇痛,镇痛泵负荷剂量2.5 mL,背景剂量为2 mL持续灌注,自控剂量1.0 mL,锁定时间20min。手术结束时、术后12 h和24 h的收缩压(SBP)、舒张压(DBP)、心率(HR),记录术后8,12,24,48 h疼痛视觉模拟评分(VAS),并记录术后镇痛期间患者不良反应。结果:2组患者手术结束、术后12,24,48 h时的SBP、DBP和HR与手术前比较差异均具有统计学意义(P<0.01),并且术后24 h和48 h时组间比较差异具有统计学意义(P<0.05或P<0.01);瑞芬太尼组患者术后8,12,24,48 h时VAS分别为1.7±0.9、1.5±1.0、1.2±0.8和1.0±0.5,与芬太尼组差异具有统计学意义(P<0.01);瑞芬太尼组不良反应发生率为22.5%,与芬太尼组差异具有统计学意义(P<0.01)。结论:瑞芬太尼用于上腹部手术后患者静脉自控镇痛效果满意、不良反应少,值得临床推荐。

OBJECtIVE To observe the effectiveness and safety of patient-controlled intravenous analgesia （PCIA） with remifentanil in the patients with upper abdominal surgery. METHODS 160 patients with upper abdominal surgery,who visited our hospital in october 2008 october 2010,were randomly divided into remifentanil group and sufentanil group. The dosages of remifentanil and sufentanil were both 0. 02 mg. kg^-1, and diluted to 100 mL with normal saline. Patients in both groups received PCIA with loading dosage of 2. 5 mL, subsequent bolus dosage of 1 mL with lockout time of 20 min and background infusion dosage of 2 mL.h^-1. Systolic blood pressure （DBP）, diastolic blood pressure（SBP）and heart rate（HR） were determined before operation,at the end of the operation, 24 h and 48 h after operation. The analgesic effect was evaluated by visual analog scale （VAS） at 8,12,24 h and 48 h after operation. The adverse reactions were recorded during the study. RESULTS SBP, DBP and HR in both groups at the end of the operation,24 hours and 48 hours after operation were significantly different from those before operation （P〈0. 01 ）, and there were significant differences between both groups at 24 hours and 48 hours after operation （P〈0. 01）. VAS in remifentanil group at 8,12,24 and 48 h after operation was 1.7±0. 9,1.5 ± 1.0,1.2±0. 8 and 1.0±0. 5, respectively, which was significantly different in statistic from those in sufentanil group （P〈0. 01 ）. The rate of adverse reaction in remifentanil groups was 22. 5% ,which was significantly different in statistic to that in sufentanil group （P〈0. 01 ）. CON- CLUSION Remifentanil is a safe and effective analgesic agent for PCIA after upper abdominal surgery,and worthy recommending in clinic.