地佐辛复合舒芬太尼用于开腹手术后静脉自控镇痛的临床研究

Clinical Research on Application of Dezoncine Combined with Sufentanil in PCIA after Abdominal Surgery

目的研究地佐辛与舒芬太尼联合镇痛对上腹部手术（大手术）运动痛和清醒镇痛的镇痛效应及其副作用。方法选择90例行开腹手术的患者，30～65岁，ASAI—II级，随机分为地佐辛组（D组），地佐辛复合舒芬太尼组（SD组），舒芬太尼组（s组），各30例。所有患者均选择全身麻醉，s组PCIA配方舒芬太尼2ug／kg，托烷司琼7mg，生理盐水稀释至100ml。D组PCIA配方：地佐辛0．8mg／kg，托烷司琼7mg，生理盐水稀释至100ml。SD组PCIA配方：地佐辛0．6mg／kg，舒芬太尼1．5ug／kg，托烷司琼7mg，生理盐水稀释至100ml。PCIA设置：背景剂量2ml／h，PCA剂量1ml／次，锁定时间15min。手术结束前10min4g电子镇痛泵行PCIA。持续监测血压，心率，呼吸率，SPO2。记录术后4、8、16、24h的VAS评分、安静和翻身运动时的镇静Ramsay评分、不良反应、镇痛泵的有效及无效按压次数和患者的镇痛满意度评分。结果s组合SD组VAS评分在术后24h明显低于D组（P〈0．01））。病人在翻身运动时VAS评分SD组和D组明显低于S组。（P〈0．05））．在4～24h镇静评分SD组和D组明显低于s组，（P〈0．01））．在术后4～24h恶心、呕吐、呼吸抑制、皮肤瘙痒、寒战等副作用的发生率SD组和D组明显低于S组。结论地佐辛复合舒芬太尼用于开腹手术术后静脉自控镇痛的镇痛效果优于单用地佐辛，并且对运动痛的镇痛效果优于单用舒芬太尼。且较单用舒芬太尼，可降低术后副作用的发生，值得在临床推广。

Objective To explore the effect and side effect of combined application of dezoncine and sufentanil in patient-controlled intravenous analgesia （PCIA） in patients after abdominal surgery. Methods 90 patients undergoing abdominal surgery, from 30 to 65 years old, of ASA （American Standards Association） grading I to II, were randomly divided into 3 groups： dezoncine group （Group D）, dezoncine plus sufentanil group （Group SD） and sufentanil group （Group S）, 30 cases in each; all the patients were given general anes- thesia; the PCIA formula for Group S was 2ug/kg of sufentanil ＋ 7mg of tropisetron in 100ml of diluted sodium chloride; the PCIA for- mula for Group D was 0.8mg/kg of dezoncine ＋ 7rag of tropisetron in 100ml of diluted sodium chloride; the PCIA formula for Group SD was 0.6mg/kg of dezoncine ＋ 1.5ug/kg of sufentanil ＋ 7mg of tropisetron in 100ml of diluted sodium chloride; PCIA was fixed as follows： background dose 2ml/h, PCA dose lml/once and lock time 15min.; 10 minutes before operation ending, electronic analgesia pump was installed to provide PCIA; continuous monitoring was made to blood pressure, heart beating, respiratory rate and SPO2; the VAS （visual analogue scale） scores at the time point of 4h, 8h, 16h and 24h after operation, the Ramsay scores in peaceful state and when turning, the effective and ineffective pressing numbers of pump, and the analgesia effect satisfaction scores and the side effects were all recorded down. Results The VAS scores of Group S and Group SD 24 hours after operation were much lower than that of Group D; the VAS scores when turning in Group SD and Group D were much lower than that in Group S as well as their scores in peace- ful state from the 4~ hour to the 24~ hour after operation; within the same time duration, the occurrence of side effects such as nausea, vomiting, respiratory depression, itch of the skin and shiver in Group SD and Group D was obviously lower than that in Group S. Con- clusions The combined application of dezocine and sufentanil in PCIA after abdominal surgery is of superior effect to the application of dezecine only and to sufentanil only for analgesia when turning and it can reduce the occurrence of side effects; it is worthy of wide application in clinic.