地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛效果的观察

Effect of dezocine combined with fentanyl for patient-controlled intravenous analgesia for elderly patients with heart disease undergoing non-cardiac surgery operation

目的:观察地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛效果及不良反应。方法:60例美国麻醉学家协会(ASA)II或III级择期行全麻手术合并高血压及缺血性心脏病老年患者,随机分为两组:芬太尼组(F组),芬太尼16μg/kg+盐酸托烷司琼10 mg+0.9%氯化钠液至总量100mL;芬太尼复合地佐辛组(FD组),芬太尼8μg/kg+地佐辛0.4 mg/kg+盐酸托烷司琼10 mg+0.9%氯化钠液至总量100 mL。两组患者镇痛液负荷量为5 mL,经静脉注射自控镇痛(PCIA)镇痛泵维持量2mL/h,追加量0.5 mL,锁定时间15 min。记录术后4 h、8 h、12 h、24 h、36 h及48h的视觉模拟评分(VAS)及Ramsay镇静评分、生命体征、术后各时段镇痛效果与镇痛泵按压次数及不良反应。结果:F组与FD组术后各时点VAS评分均<3分,两组间差异无统计学意义(P>0.05);F组术后8 h、12 h及24 h的Ramsay镇静评分明显高于FD组(P<0.05);镇痛期间不良反应发生率FD组低于F组(P<0.05)。结论:地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛治疗,其镇痛效果良好,不良反应发生率低。

Objective：To observe the analgesic efficacy and safety of dezocine combined with fentanyl for patient-controlled intravenous analgesia（PCIA） for elderly patients with heart disease undergoing non-cardiac surgery operations.Methods： Sixty ASA II or III elderly patients with heart disease undergoing general anesthesia for non-cardiac surgeries were randomized into two groups： the fentanyl group（group F） and the dezocine combined with fentanyl group（group FD）.The medicatiors for PCIA ware as follows： in group F,16μg/kg fentanyl with 10mg tropisetron in 100 mL 0.9%NaCl;the group FD,l8μg/kg fentany,0.4mg/kg dezocine and 10mg tropisetronin in 100 mL 0.9%NaCl;in both groups loading dose was 5mL,the infusion rate 2 mL/h,bolus dose was 0.5 mL,and lockout time was 15min.Visual analog score（VAS） of pain and Ramsay sedation score were measured at 4 h,8 h,12 h,24 h,36 and 48 h during the postoperative analgesia.The side effects were recorded for every enrolled patient.Results：In the two groups,the analgesia scorings were all 3 at each time points but without significant difference between the two groups.The Ramsay scores in the group F were significant higher than that of group FD at 8 h,12 h,24 h（P0.05）.Postoperatively the incidence of side effects were lower in the group FD than that of the Group.F（P0.05）.Conclusion： Dezocine combined with Fentanyl produces significant analgesia effection in elderly patients with heart disease after non-cardiac surgery,meanwhile less side effects were observed.