地佐辛联合舒芬太尼应用于单侧肺叶切除术后镇痛镇静的效果

Effect of sufentanil combined with dezocine on patient-controlled intravenous analgesia after thoracic unilateral lobectomy

目的比较地佐辛、舒芬太尼及地佐辛联合舒芬太尼用于单侧肺叶切除术后镇痛镇静的临床效果及不良反应。方法将60例择期行单侧肺叶切除术的患者随机分为地佐辛组、舒芬太尼组及地佐辛联合舒芬太尼组,每组20例。所有患者行患者静脉自控镇痛(PCIA)。电子静脉镇痛泵中的药物配方:地佐辛组,地佐辛0.8mg/kg加0.9%氯化钠溶液至100mL;舒芬太尼组,舒芬太尼3μg/kg加0.9%氯化钠溶液至100mL;地佐辛联合舒芬太尼组,舒芬太尼1.5μg/kg联合地佐辛0.4mg/kg加0.9%氯化钠溶液至100mL。记录并比较术后0.5h(T1)、12h(T2)、24h(T3)、48h(T4)的疼痛视觉模拟评分(VAS评分)和Ramsay评分以及术后不良反应发生情况。结果 3组间在T1时间点的疼痛VAS评分和Ramsay评分的差异均无统计学意义(P值均>0.05)。地佐辛联合舒芬太尼组与舒芬太尼组和地佐辛组间在T2、T3、T4时间点的疼痛VAS评分和Ramsay评分的差异均有统计学意义(P值均<0.05),舒芬太尼组与地佐辛组间的差异也均有统计学意义(P值均<0.05)。3组间不良反应发生率的差异均无统计学意义(P值均>0.05)。结论在行单侧肺叶切除术的患者中,舒芬太尼术后镇痛的效果优于地佐辛及两者联合应用。

Objective To compare the clinical outcomes and adverse effects of dezocine,sufentanil and dezocine combined with sufentanil for postoperative analgesia after unilateral lobectomy.Methods Sixty patients scheduled for unilateral lobectomy were randomly divided into three groups（n=20）.All the patients underwent patient-controlled intravenous analgesia（PCIA） after surgery.Dezocine 0.8 mg/kg,sufentanil 3 μg/kg,and dezocine 0.4 mg/kg＋sufentanil 1.5 μg/kg were diluted with normal saline to 100 mL in group D,group S and group DS,respectively.Visual analog scale（VAS） score,Ramsay sedation score,and adverse effects were recorded at 0.5 h（T1）,12 h（T2）,24 h（T3）,and 48 h（T4） after surgery.Results There were no significant differences in VAS and Ramsay scores at T1 among the three groups（all P0.05）.There were significant differences in VAS and Ramsay scores at T2,T3,and T4 among the three groups（all P0.05）.The incidences of adverse effects were not statistically different between groups（all P0.05）.Conclusion PCIA with sufentanil is more effective than dezocine alone or in combination with sufentanil for analgesia after unilateral lobectomy.（Shanghai Med J,2012,35：856-858）