开颅手术后小剂量芬太尼PCIA对患者血浆内皮素的影响

Effect of PCIA with Low-dose Fentanyl on Plasma Endothelin after Craniotomy

目的观察开颅手术后用小剂量芬太尼PCIA对患者血浆内皮素的影响.方法择期手术的神经外科患者47例,随机分为2组.实验组26例,术毕静注镇痛负荷量芬太尼50μg后,接上芬太尼PCIA镇痛泵(芬太尼15μg/kg+恩丹斯琼8 mg加入100 mL生理盐水);对照组术毕静注5 mL生理盐水后,不接镇痛泵.监测2组术前、术毕、术后2 h、4 h、8 h、24 h、48 h时间段的HR、MBP、VSA、血浆内皮素、副作用的变化,并进行比较.结果实验组术后2 h、4 h、8 h、12 h、24 h、48 h心率低于对照组(P<0.05);实验组术毕及术后2 h平均动脉压低于对照组(P<0.05);实验组术后8 h、24 h、48 h,血浆内皮素低于对照组(P<0.05);术后2 h、4 h、8 h、12 h、24 h、48 h两组间VAS评分差异有统计学意义(P<0.05):实验组术后2 h、4 h、8 h、12 h、24h VAS0-3分(无痛-轻度疼痛)病例数及百分比明显高于对照组(P<0.05);副作用方面,意识状况、呼吸抑制、呕吐、镇静评分等副作用2组差异无统计学意义(P>0.05);实验组发生恶心的次数较多.结论开颅手术后用小剂量芬太尼PCIA镇痛效果良好,副作用小,可减少血浆内皮素的生成,进而缓解脑损伤的程度.

Objective To investigate the effect of PCIA with low-dose fentanyl on plasma endothelin （ET） after craniotomy. Methods 47 cases of selected craniotomy were divided randomly into two groups ：experimental group （26cases） and control group （21cases） . Patients in experimental group were treated with PCIA （fentanyl 15ug/kg ＋ondansetron 8 mg＋100 mL NS） but patients in control group were not given PCIA. Then HR,MBP, VAS, ET and side-effects were observed and compared between two groups before treatment and 0, 2, 4, 8, 12, 24, 48 h after treatment.Results In experimental group, HR was lower at 2, 4, 8, 12, 24 and 48 h after treatment than control group. MBP was lower at 0 and 2h after treatment in experimental group than control group. Plasma levels of ET were lower at 8, 24 and 48h after treatment in experimental group than control group. There were significant differences in VAS scores at 2,4,8,12,24 and 48 h after treatment between two groups. There was no significant differences in side reactions including consciousness, respiratory depression, vomiting and sedation between two groups. The incidence of nausea was higher in experimental group than control group. Conclusion PCIA with low-dose fentanyl after craniotomy has good analgesic effect and few side reactions, can reduce the formation of plasma endothelin, and then alleviate brain damage.