地佐辛和氟比洛芬酯联合术后自控静脉镇痛研究

Effect of dezocine and flurbiprofen axetil used in combination for patient-controlled intravenous analgesia following surgery

目的比较地佐辛、芬太尼、氟比洛芬酯联合地佐辛应用于术后患者静脉自控镇痛(PCIA)的有效性和安全性。方法选择240例行择期手术,ASA分级Ⅰ～Ⅲ级,年龄18～65岁的患者。随机分为3组:地佐辛组(D组)、氟比洛芬酯+地佐辛组(FD组)、芬太尼组(F组)、每组各80例。术后行PCIA,地佐辛组(D组):负荷量地佐辛5 mg,镇痛泵为地佐辛1.0 mg/kg+昂丹司琼8 mg+0.9%氯化钠注射液;氟比洛芬酯+地佐辛组(FD组):负荷量氟比洛芬酯25 mg+地佐辛2.5 mg,镇痛泵为氟比洛芬酯1 mg/kg+地佐辛0.8 mg/kg+昂丹司琼8 mg+0.9%氯化钠注射液;芬太尼组(F组):负荷量芬太尼1μg/kg,镇痛泵为芬太尼15μg/kg+昂丹司琼8 mg+0.9%氯化钠注射液;容量均为100 ml。镇痛泵参数设定均为持续输注量2 ml/h,PCA量0.5 ml,锁定时间15 min。采用疼痛视觉模拟评分(VAS评分)和Ramsy镇静评级评估患者48 h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、48 h时采集外周静脉血测定血浆皮质醇浓度。结果 3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)无显著差异(P>0.05),各组在同时点的Ramsy镇静评级无显著差异(P>0.05),各组在同时点的血浆皮质醇无显著差异(P>0.05)。各组均存在不良反应,但芬太尼组不良反应发生率显著高于其他两组(P<0.05);氟比洛芬酯-地佐辛组的不良反应发生率显著低于其他两组(P<0.05)。结论地佐辛与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,是一种可行、安全、有效的镇痛方法。

Objective To evaluate the efficacy and safety of dezocine, fentanyl, dezocine combined flurbiprofen axetil, used for postoperative patient-controlled intravenous analgesia （PCIA） in patients undergoing surgery. Methods Two hundred and forty ASAⅠ-Ⅲ, eighteen-sixty five years old patients undergoing elec- tive surgeries, were randomized equally into 3 groups ： dezocine group （ group D）, dezocine combined flurbipro- fen axetil group （groups FD）, fentanyl group （group F）, and all reeeived postoperative PCIA. For postopera- tive PCIA, the patients in group D received a protocol of dezocine 5 mg as loading dose and dezocone（ 1.0 mg/ kg） ＋ ondansetron （8 mg） ＋ 0. 9 % Nacl solution,those in group FD receive dezocine 2. 5 mg combined flur- biprofen axetil 25 mg as loading dose and flurbiprofen axetil （1 mg/kg） ＋ dezocone（0. 8 mg/kg） ＋ ondanse- tron（ 8 mg） ＋ 0. 9% Nacl solution, And those in group F had a protocol of fentanyl 1 Ixg/kg as loading dose and fentanyl（ 15 μg/kg） ＋ ondansetron （8 mg） ＋ 0. 9% Nacl solution. 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 patients showed good pain relief with PCIA. In three groups, the VAS scores did not indicate a statistically significant difference （ P 〉 0. 05 ）, and in three groups, the differences of the average Ramsay score were not significant（ P 〉 0.05 ）. The plasma cortisol of three groups were not significant difference （P 〉 0. 05 ）. The in- cidence of adverse effect of group F was higher significantly than other 2 group （ P 〈 0. 05 ）, the incidence of adverse effect of group FD was lower significantly than other 2 group （ P 〈 0. 05 ）. Conclusion PCIA with a combination of flurbiprofen axeyil and produces satisfactory analgesic effect, and can significantly reduce adverse effects.