地佐辛、布托啡诺和氟比洛芬酯联合自控静脉镇痛研究

Effect of Dezocine,Butorphanol and Flurbiprofen axetil used in combination for patient-controlled intravenous analgesia following surgery

目的比较地佐辛、布托啡诺、舒芬太尼、地佐辛联合氟比洛芬酯、布托啡诺联合氟比洛芬酯应用于术后患者自控静脉镇痛(PCIA)的有效性和安全性。方法选择400例行择期手术,ASA分级Ⅰ～Ⅲ级,年龄18～65岁的患者。随机分为5组:地佐辛组(D组)、地佐辛+氟比洛芬酯组(DF组)、布托啡诺(B组)、布托啡诺+氟比洛芬酯(BF组)、舒芬太尼组(S组),每组各80例。术后行PCIA,地佐辛组(D组):负荷量地佐辛5mg,镇痛泵为地佐辛1.0mg/kg+昂丹司琼8mg+0.9%氯化钠注射液;地佐辛+氟比洛芬酯组(DF组):负荷量地佐辛2.5mg+氟比洛芬酯25mg,镇痛泵为地佐辛0.8mg/kg+氟比洛芬酯1mg/kg+昂丹司琼8mg+0.9%氯化钠注射液;布托啡诺(B组):负荷量为布托啡诺1mg,镇痛泵为布托啡诺0.4mg/kg+昂丹司琼8mg+0.9%氯化钠注射液;布托啡诺+氟比洛芬酯组(BF组):负荷量为布托啡诺1mg+氟比洛芬酯25mg,镇痛泵为布托啡诺0.3mg/kg+氟比洛芬酯1mg/kg+昂丹司琼8mg+0.9%氯化钠注射液;舒芬太尼组(S组):负荷量舒芬太尼0.1μg/kg,镇痛泵为芬太尼2μg/kg+昂丹司琼8mg+0.9%氯化钠注射液;镇痛泵容量均为100ml。镇痛泵参数设定均为持续输注量2ml/h,PCA量0.5ml,锁定时间15min。采用疼痛视觉模拟评分(VAS评分)和Ramsy镇静评级评估患者48h内的疼痛程度和镇静情况,同时记录不良反应发生情况,并于术后4、12、24、48h时采集外周静脉血测定血浆皮质醇浓度。结果 5组患者均获得良好的镇痛效果,各组在同时点的疼痛视觉模拟评分(VAS)差异无统计学意义(P>0.05),各组在同时点的Ramsy镇静评级差异无统计学意义(P>0.05),各组在同时点的血浆皮质醇差异无统计学意义(P>0.05)。各组均存在不良反应,但舒芬太尼组不良反应发生率显著高于其他4组(P<0.01);地佐辛-氟比洛芬酯组和布托啡诺-氟比洛芬酯组的不良反应发生率显著低于其他各组(P<0.05)。结论地佐辛-氟比洛芬酯、布托啡诺-氟比洛芬酯联合用于术后PCIA能达到满意的镇痛效果,同时可减少不良反应,是可行、安全、有效的镇痛方法。

Objective To evaluate the efficacy and safety of Dezocine, Butorphanol, Sufentanil, Dezo- cine combined Flurbiprofen axetil, Butorphanol combined flurbiprofen axetil, used for postoperative patient-con- trolled intravenous analgesia （ PCIA ） in patients undergoing surgery. Methods Four hundred ASA I -Ⅲ, eighteen-sixty five years old patients undergoing elective surgeries, were randomized equally into 5 groups： Dezoeine group （group D ）, Dezocine combined flurbiprofen axetil group （group DF）, Butorphnol group （group B）, Butorphnol combined flurbiprofen axetil group （group BF） , Sufentanil group（ group S）, and all received postoperative PCIA. For postoperative PCIA, the patients in group D received a protocol of dezocine 5 mg as loading dose and dezoeone（ 1.0 mg/kg） ＋ ondansetron （ 8 rag） ＋ O. 9 % NaC1 solution in pump, those in group DF receive Dezoeine 2. 5 mg combined flurbiprofen axetil 25 mg as loading dose and flurbiprofen axetil （ 1 mg/kg） ＋ dezocone（O. 8 mg/kg） ＋ ondansetron （8 mg） ＋ 0. 9% NaC1 solution in pump, those in group B receive Butorhphnol 1 mg as loading dose and butorphnol（O. 4 mg/kg） ＋ ondansetron （8 mg） ＋ 0. 9% NaC1 solution in pump, those in group BF receive butorphnol 0. 5 mg combined flurbiprofen axetil 25 nag as loading dose and flurbiprofen axetil （1 mg/kg） ＋ dezoeone（0. 3 mg/kg） ＋ ondansetron （8 mg） ＋ 0. 9% NaC1 solu- tion in pump, And those in group S had a protocol of sufentanil O. 1 Ixg/kg as loading dose and sufentanil（ 2 pLg /kg） ＋ ondansetron （8 mg） ＋ O. 9% NaC1 solution in pump. All the anesthetic agents were diluted to 100 mI and infused by a pump at the background dose rate of 2 ml/h with a patient-controlled bolus of 0. 5 ml and the lock out time of 15 rain. The visual analogue scale（VAS） and Ramsay scores were used to evaluate the analgesic effect at 2,4,8,12,24 and 48 h after surgery, plasma cortisol were detected at 4,12,24 and 48 h after surgery, and the adverse effects associated with PCIA were recorded in the 48 h post-operatively. Results All the pa- tients showed good pain relief with PCIA. In three groups, the VAS Scores did not indicate a statistically signifi-cant difference （P 〉 0. 05）, and in three groups, the differences of the average Ramsay score were not signifi- cant（ P 〉 0. 05 ）. The plasma cortisol of three groups were not significant difference （ P 〉 0.05 ）. The incidence of adverse effect of group S was higher significantly than other 4 group （P 〈 O. 01 ）, the incidence of adverse effect of group DF and group BF were lower significantly than other group（P 〈 0.05）. Conclusion PCIA with dezocone combined flurbiprofen axeyil, and butorphnol combined flurbiprofen axeyil, produces satisfactory anal- gesic effect, and can significantly reduce adverse effects.