喷他佐辛与芬太尼在食管胸中段癌术后自控镇痛的效果比较

Effect comparison of pentazocine and fentanyl in patient controlled intravenous analgesia after the chest segment esophageal cancer surgery

目的研究食管胸中段癌术后静脉自控镇痛(PCIA)时应用喷他佐辛的镇痛效果和不良反应,并与芬太尼作比较。方法选择本院2011年6月～2012年5月行食管胸中段癌根治术的患者60例,ASAⅠ～Ⅱ,NYHAⅠ～Ⅱ级,随机分为两组:喷他佐辛组(P组),配喷他佐辛3mg/kg;芬太尼组(F组),配芬太尼10μg/mL。两组术后镇痛均应用一次性电子静脉自控输注泵,采用LCP模式:负荷量5mL+持续量2mL+单次按压注入量0.5mL,锁定时间15min,容量为100mL。观察患者术后4、8、24h的疼痛、镇静评分,镇痛效果总体评价及不良反应。结果两组镇痛、镇静效果差异无统计学意义(P>0.05);P组发生恶心呕吐1例(3.3%),F组发生6例(20%),差异有统计学意义(P<0.05);P组发生皮肤轻度瘙痒0例,F组发生5例(16.7%),差异有统计学意义(P<0.05)。P组不良反应发生率为3.3%,F组为43.4%,两组间比较差异有统计学意义(P<0.01)。结论 PCIA应用喷他佐辛与芬太尼均能达到良好的镇痛效果,但喷他佐辛的不良反应发生率较低。

Objective To study the analgesic effects and adverse reactions of pentazocine in the patient controlled intravenous analgesia after chest esophageal cancer surgery, and compare with fentanyl. Methods Sixty patients （ASA I-Ⅱ, NYHA I -Ⅱ） undergoing radical resection of esophageal chest paragraph cancer were randomly divided into two groups： pentazocine group （P group）, pentazocine 3 mg/kg; fentanyl group （F group）, fentanyl 10 μg/kg. Controlled application of disposable electronic intravenous pump was used in postoperative analgesia with LCP mode： load capacity was 5 mL, con- tinuous injection was 2 mL, continuous injection volumes of single compression was 0.5 mL, lockout time was 15 min, with a capacity of 100 mL. Analgesia and sedation score, the overall evaluation of analgesic effect and adverse reactions of two groups on 4, 8 and 24 h were observed. Results There were no significant differences with analgesic and sedative effect between two groups （P 〉 0.05）; Nausea and vomiting occoured in 1 case （3.3%） in P group, 6 cases （20%） in F group, there were significant differences between two groups （P 〈 0.05）; Mild skin itching occurred in 0 cases in P group, 0 case in F group, 5 patient （16.7%）, there were significant differences between two groups （P 〈 0.05）. Adverse reactions occurred in 1 case （3.3%） in P group, 3 cases （43.4%） in F group, there were significant differences between two groups （P 〈 0.01）. Conclusion PCIA applicating pentazocine and fentanyl has a good analgesic effect, but pentazocine has lower incidence of adverse reactions.