舒芬太尼复合氯胺酮、托烷司琼用于术后静脉镇痛的临床观察

Clinical observation of sufentanil combined with ketamine,tropisetron for postoperative intravenous analgesia

目的 比较单纯舒芬太尼静脉镇痛与舒芬太尼复合氯胺酮、托烷司琼用于腹腔镜胆囊切除术的术后静脉镇痛的效果.方法 选择ASA Ⅰ～Ⅱ级的全身麻醉下腹腔镜胆囊切除术要求术后镇痛的患者200例,随机分成SUF、SKT组,每组各100例,实行术后静脉镇痛.SUF组静脉镇痛配方：舒芬太尼100 μg,加盐水至100 ml；SKT组静脉镇痛配方：舒芬太尼100 μg,氯胺酮300 mg,托烷司琼4 mg,加盐水至100 ml.所有患者术终都只用新斯的明拮抗维库溴胺的肌松作用,不用纳洛酮,术后2、4、12、24h,观察记录各组的镇痛情况及不良反应.结果 SKT组的镇痛效果优于SUF组,且恶心呕吐的不良反应发生率降低,未发现致幻反应.结论 SKT组静脉镇痛配方适用于全身麻醉下腹腔镜胆囊切除术的术后镇痛.

Objective To compare the effect of sufentanil alone and sufentanil combined with ketamine,tropisetron for postoperative intravenous analgesia after laparoscopic cholccystectomy. Methods 200 patients with ASA I-II in demand of postoperative analgesia after laparoscopic cholecystectomy under general anesthesia were selected and randomly divided to the SUF group and the SKT group.Each group contained 100 cases and was given postoperative intravenous analgesia.As for the intravenous analgesia prescriptlon,the SUF group was given 100 ？g sufentanil with addition of saline to 100ml;the SKT group was given 100 ptg sufentanil,300 mg ketamine and 4 mg tropisctron with addition of saline to 100 ml. All the patients were given neostigmine instead of naloxone after the surgery to antagonize muscle re- laxation effects induced by veeuronium.The analgesic effect and adverse effects of both groups were recorded at 2,4,12 and 24 hours after surgery. Results Compared with the SUF group, the SKT group had better analgesic effect with fewer adverse effects of nausea and vomit and no hallucinogenic reaction. Conclusion The intravenous analgesic prescription of SKT group is applicable for postoperative analgesia after laparoscopie cholecystectomy under general anesthesia.