喷他佐辛应用于神经外科开颅手术术后镇痛效果的观察

Observation of the analgesic effect of Pentazocine after craniotomy

目的:随机双盲对比观察不同剂量的喷他佐辛用于颅脑术后的镇痛效果及不良反应。方法:择期全麻颅脑手术患者90例(ASAⅠ～Ⅱ),将其随机分为喷他佐辛90 mg组(Ⅰ组,n=30)、120 mg组(Ⅱ组,n=30)和150 mg组(Ⅲ组,n=30)。术中吸入七氟烷行全身麻醉。根据分组向患者自控镇痛泵(PCA)中注入喷他佐辛,并均以生理盐水稀释到100 ml,设置背景剂量1.5 ml/h,单次剂量0.5 ml,间隔时间15 min。术中缝硬膜时接上电子镇痛泵实行静脉自控镇痛(patient controlled intravenous analgesia,PCIA)。记录术后清醒时、4 h、16～20 h、24 h、40～44 h、48 h、64～68 h、72 h的平均动脉压(MAP)、心率(HR)、呼吸(R)、血氧饱和度(SpO2)、VAS评分、疼痛部位、疼痛性质、PCA累积总量、PCA按压用量、累计按压次数及累计有效按压次数,观察恶心、呕吐、皮肤瘙痒、呼吸抑制、颜面水肿及球结膜水肿的发生情况。结果:Ⅱ、Ⅲ组患者的PCIA按压次数、有效按压次数明显低于Ⅰ组(P<0.05)。Ⅱ、Ⅲ组患者术后24 h内补救用药的使用例数明显少于Ⅰ组(P<0.05)。结论:颅脑术后3 d内采用PCA持续泵注喷他佐辛120 mg(平均用量1.79 mg/h)和150 mg(平均用量2.25 mg/h)均能到达满意的术后镇痛效果,而前者的量效比更为合理。

Objective： To investigate the efficacy of analgesia and adverse effects of Pentazocine with different doses after craniotomy.Methods： 90 neurosurgical patients requiring selective operation with general anesthesia（ASA physical Ⅰ-Ⅱ） were randomly allocated into Pentazocine 90 mg group（group Ⅰ,n=30）,120 mg group（group Ⅱ,n=30） and 150 mg group（group Ⅲ,n=30）.Patients were taken Sevoflurane to perform general anesthesia during intraoperation.According to the sectionalization,Pentazocine was injected into patient controlled analgesia（PCA） of patients,which was diluted into 100 ml with normal saline.The basal infusion was 1.5 ml/h,single dose was 0.5 ml,spacing interval was 15 min.When sewing the dura mater during the operation,electronic analgesic pump was used to perform patient controlled intravenous analgesia（PCIA）.The MAP,HR,R,SpO2,VAS scores,ache spot,ache feature,amounts of PCA,press dosage,total times of press and effective times of press were recorded when the patients were awake and in 4 h,16-20 h,24 h,40-44 h,48 h,64-68 h,72 h after the operation.The conditions of nausea,vomit,pruritus,respiratory depression,facial edema and chemosis were observerd.Results： The number of successfully delivered doses and attempt in group Ⅱ and group Ⅲ were lower than group Ⅰ（P0.05）.Rescue medication in group Ⅱ and group Ⅲ was lower than group Ⅰ during the first 24 h after operation（P0.05）.Conclusion： The treatment of PCA continuous pump injection with Pentazocine 120 mg（average continuous infusion 1.79 mg/h） and 150 mg（average continuous infusion 2.25 mg/h） for 3 days after operation both can get good effect,while the effect of former is more reasonable.