围术期静脉注射牛痘疫苗致炎兔皮提取物用于腰椎术后镇痛

Clinical effect of perioperative injection of analgecine on patient-controlled intravenous analgesia of fentanyl in lumbotomy patients

目的评价围术期静脉注射牛痘疫苗致炎兔皮提取物对腰椎手术后患者自控静脉镇痛的临床效果。方法选择全身麻醉下腰椎手术患者200例，术后采用芬太尼经0．9％氯化钠注射液稀释后行患者自控静脉镇痛（PCIA），并根据不同用药方法随机分为四组：A组，芬太尼1．0mg＋0．9％氯化钠溶液共100ml；B组，芬太尼0．5mg＋0．9％氯化钠溶液共100ml；C组，术前晚、麻醉前、术毕各经静脉注射牛痘疫苗致炎兔皮提取物3．6U，芬太尼1．0mg＋0．9％氯化钠溶液共100ml；D组，术前晚、麻醉前、术毕各经静脉注射牛痘疫苗致炎兔皮提取物7．2U，芬太尼0．5nag＋0．9％氯化钠溶液共100ml。每组50例。术后24h内采用视觉模拟评分（VAS）、PCA按压次数观察各组镇痛效果及恶心呕吐、嗜睡等不良反应的发生率。结果B组术后2h的VAS评分为（5．2±1．9）分，显著高于A、C和D组（F：8．2，P〈0．05），而4h后四组间VAS差异无统计学意义（P〉0．05）。24h内PCA按压次数B组为（14．2±1．8）次，显著多于A、C和D组（F=12．8，P〈0．05）。B、D组中恶心、呕吐、皮肤瘙痒及嗜睡等不良反应的发生率显著低于A和C组（X2=29．6、10．1，均P〈0．05）。结论围术期静脉注射牛痘疫苗致炎兔皮提取物复合小剂量芬太尼用于腰椎手术后静脉镇痛可取得满意的镇痛效果，并能减少芬太尼用量及不良反应发生率。

Objective To compare the effect of perioperative intravenous injection of Analgecine on the anal- gesic efficacy and complications of patient-controlled intravenous analgesia （PCIA） of different doses of fentanyl in postoperative lumbotomy patients. Methods 200 patients underweat lumbotomy in general anesthesia were randomly divided into four groups with fifty cases each. Fentanyl 1.0mg in group A ,fentanyl 0.5mg in group B ,fentanyl 1.0rag in group C,fentanyl 0.5mg in group D. The drugs in each group were diluted to 100ml and infused by pumps. Be- sides, the patients in group C and D were injected with analgecine 3.6u and 7.2u at the night before the operation, preoperation and postoperation respectively. The visual analog scale（VAS） ,times of PCA and incidence of side effects were recorded during the period of postoperative 24 hours. Results The VAS of group B at 2h after operation was （ 5.2 ± 1.9 ） points, which was significantly higher than that of group A, C and D （ P 〈 0.05 ）, VAS became similar 4h later（ P 〉0.05 ）. The demanding times for supplemental bolus in group B were also significantly higher than that of A, C and D（ P 〈 0.05）. The incidence of nausea, vomiting, itching, somnolence in group B and D were significantly less than those in group A and C （ P 〈 0.05 ）. No respiratory depression or abnormal bleeding occurred in the four groups. Conclusion Perioperative intravenous injection of analgecine had a better effect on PCIA of tentanyl and could reduce fentanyl requirement and its side effects in lumbotomy patients.