舒芬太尼复合曲马多用于胸腔镜下肺大泡切除术后患者自控静脉镇痛的临床观察

Clinical observation of sufentanil combined with tramadol for Patient-controlled intravenous analgesia after lung bullae surgery with thoracoscope

目的观察舒芬太尼复合曲马多用于胸腔镜下肺大泡切除术后患者自控静脉镇痛(PCIA)的临床疗效与不良反应。方法选择择期行胸腔镜下肺大泡切除术后自控静脉镇痛患者90例,年龄17～58岁,体质量48～60kg,ASA Ⅰ～Ⅱ级,随机分为两组,每组45例。Ⅰ组:舒芬太尼0.1mg+托烷司琼3mg,Ⅱ组:舒芬太尼0.05mg+曲马多500mg+托烷司琼3mg,两组均以0.9%氯化钠溶液稀释至100mL。电子镇痛泵设定方法:背景剂量2mL/h,自控追加剂量2mL/次,锁定时间15min。观察和记录术后4、12、24、48h各时间点的视觉模拟评分(VSA)、镇静评分(SS)、舒适度评分(BCS)及不良反应的发生情况。结果手术后4h时Ⅰ组的镇痛效果及舒适度均高于Ⅱ组(P<0.05),但在其余各时间点时两组VAS镇痛评分和BCS评分差异均无统计学意义(P>0.05)。术后4h和12h时Ⅰ组患者的镇静评分明显高于Ⅱ组(P<0.05),两组患者恶心、呕吐、呼吸抑制的发生率差异均无统计学意义(P>0.05),但Ⅰ组皮肤瘙痒发生率明显高于Ⅱ组(P<0.05)。结论舒芬太尼复合曲马多更适合用于胸腔镜下肺大泡切除术后患者自控静脉镇痛。

Objective To observe the clinical effects and side effects of sufentanil combined with tramadol for patient-controlled intravenous analgesia（PCIA）after lung bullae surgery with thoracoscope. Methods Ninety ASA I -II patients aged 17-58 years old,body mass 48-60 kg,scheduled for elective lung bullae surgery with thoracoscope were studied. Patients in our study were randomly divided into two groups（forty-five cases in each group）. Group I ： sufentanil 0.1 mg ＋ tropisetron 3 mg; group II ： sufentanil 0.05 mg＋ tramadol 500 mg ＋ tropisetron 3 mg. Two groups of drugs were both diluted to 100ml with 0.9% sodium chloride solution. PCIA parameters were a bolus dose of 2 ml,lockout interval of 15minutes and continuous infusion of 2 ml/h. The visual analogue scale（VAS）, sedation scores（SS）, bruggman comfort scale（BCS）and side effects at 4,12,24, and 48h postoperatively were observed and recorded. Results Analgesic effects and the degree of comfort in group I were superior to group II at 4h postoperatively,but there was no difference between the two groups in VAS and BCS at 12, 24,, and 48h postoperative analgesia. Group I was higher than group I1 at 4h and 12h of SS. The rates of postoperative nausea, vomiting and respiratory depression were not significantly different between two groups, but the incidence of skin itching in group I was significantly higher than in group II . Conclusion Sufentanil combined with tramadol were more suitable for patient-controlled intravenous analgesia after lung bullae surgery with thoracoscope.