地佐辛联合芬太尼应用于腰椎内固定术后镇痛的疗效

Effects of dezocine combined with fentanyl in patient-controlled intravenous analgesia after lumbar internal fixation

目的观察地佐辛联合芬太尼应用于腰椎内固定术后患者静脉自控镇痛(PCIA)的效果。方法选择美国麻醉医师学会分级Ⅰ～Ⅱ级,择期行腰椎内固定术的患者90例,随机分为地佐辛组(D组)、芬太尼组(F组)和地佐辛联合芬太尼组(DF组),每组30例,均采用气管插管、全凭静脉麻醉,术后行PCIA。PCIA配方:D组为地佐辛0.8mg/kg,F组为芬太尼16μg/kg,DF组为地佐辛0.4mg/kg加芬太尼8μg/kg,均加0.9%氯化钠溶液稀释至100mL。观察3组患者在术后3、6、12、24、48h疼痛视觉模拟评分(VAS评分),镇静程度评分(Ramsay评分),48h内PCIA按压次数及有效次数,芬太尼累积消耗量,患者总体满意度,以及不良反应发生情况。结果术后镇痛期间3组患者的心率、血压、脉搏血氧饱和度均在正常范围内。3组在术后各时间点的疼痛VAS评分、镇静Ramsay评分、PCIA按压总次数及有效次数的差异均无统计学意义(P值均>0.05)。DF组术后各时间点的芬太尼累积消耗量均显著少于F组(P值均<0.01)。F组的总不良反应发生率为53.3%,显著高于D组的20.0%和DF组的6.7%(P值分别<0.05、0.01),D组又显著高于DF组(P<0.01)。DF组对术后镇痛的总体满意率为90.0%,显著高于F组的60.0%(P<0.01)。结论地佐辛联合芬太尼应用于腰椎内固定术后PCIA镇痛效果确切可靠,可减少芬太尼用量,患者术后的总体满意度高且不良反应发生率低。

Objective To evaluate the effects of patient-controlled intravenous analgesia （PCIA） with dezocine and fentanyl after lumbar spine fixation. Methods Ninety patients with American Society of Anesthesiologists （ASA） I - Ⅱ were scheduled for lumbar internal fixation and randomly divided into dezocine group （D）, fentanyl group （F）, and dezocine combined with fentanyl group （DF）. There were 30 patients in each group. Intravenous anesthesia with tracheal intubation and PCIA were performed in all the patients. PCIA ingredients were as follows： in group D, dezocine 0.8 mg/kg with 0.9% normal saline diluted to 100 mL in group F, fentanyl 16 μg/kg with 0.9% normal saline diluted to 100 mL; and in group DF, dezocine 0.4 mg/kg＋ fentany 8μg/kg with 0.9% normal saline diluted to 100 mL. Visual analogue scale （VAS） and Ramsay scores were recorded 3, 6, 12, 24 and 48 h postoperatively. The total press times and the effective times of PCIA, fentanyl consumption, adverse reactions, and patients satisfaction were evaluated within 48 h after surgery. Results The heart rate （HR）, blood pressure （BP） and pulse oxygen saturation （SpO2） in the three groups were in the normal range during PCIA. There was no significant difference in VAS score, Ramsay score, the total press times and the effective times at each time point in the three groups （P〉O. 05）. Compared with F group, DF group had less consumption of fentanyl at each time point （ P〈O. 01 ）. The total incidence rates of adverse reactions in F group, D group and DF group were 53.3%, 20%, and 6.7%, respectively. There were significant differences in the incidence rates between groups （P〈0.05 or P〈O. 01）. Patients＇ satisfaction in DF group was significantly higher than that in F group （90% vs. 60%, P〈O. 01）. Conclusion PCIA with dezocine and fentanyl is an effective method for the postoperative analgesia in lumbar internal fixation. It can reduce the consumption of fentanyl and has high patient satisfaction and low incidence of adverse reactions. （Shanghai Med J, 2012, 35： 295-297）