地佐辛联合芬太尼对老年关节置换术患者术后镇痛效果及致痛物质的影响

Impact of dezocine combined with fentanyl analgesia on pain caused by substances in elderly patients undergoing total joint replacement

目的：研究地佐辛联合芬太尼对老年骨科手术患者术后镇痛效果及对血清五羟色胺（5-HT）和P物质（SP）的影响。方法拟于全麻下行人工关节置换手术老年患者90例，ASAI～II级，随机分为3组，每组30例：地佐辛组（A组）、芬太尼组（B组）和地佐辛联合芬太尼组（C组）。3组分别于术毕前10min静脉注射镇痛泵中的镇痛液5ml作为负荷量，术毕清醒拔除气管导管后静脉接PCA泵泵入。镇痛液配制：A组为地佐辛0Ζ．5mg/kg，B组为芬太尼10μg/kg，C组为地佐辛0．25mg/kg＋芬太尼5μg/kg，各组泵中均加入昂丹司琼8mg及生理盐水总共配制成100ml，背景输注速率2ml/h，PCA量0．5ml，锁定时间15min。采用VAS评分法和Ramsay评分法分别于术后2、6、12、24及48h评价镇痛效果和镇静水平；测定麻醉前及术后12、24、48h血清5-HT和SP浓度；记录术后48h内不良反应的发生情况。结果与术后2h比较，3组术后24、48hVAS评分和Ramsay评分均有所下降（P＜0．05）；与A、B组比较，C组术后2、6、12、24hRamsay评分明显较高（P＜0．05）。与麻醉前比较，3组患者术后12、24、48h血清5-HT和PS浓度显著升高（P＜0．05）；与A、B组比较，C组术后12、24、48h血清5-HT和SP浓度明显降低（P＜0．05）；A、B2组各时点5-HT和SP比较差异均无统计学意义（P＞0．05）。与A、B组比较，C组患者恶心呕吐、呼吸抑制、头晕发生率明显较低（A组16．7％，B组26．7％，C组6．7％，P＜0．05）。结论地佐辛与芬太尼联合应用于老年人工关节置换手术后自控静脉镇痛，可有效缓解术后疼痛，抑制术后5-HT和SP浓度的升高，不良反应发生少，优于二者单独使用，值得临床推广应用。

Objective To observe the efficacy of the combination of dezocine and fentanyl , and to investigate the effect on serum 5-hydroxytryptamine （5-HT） and P substance （SP）.Methods Ninety ASA I or II patients undergoing elec-tive total hip replacement operation in general anesthesia randomly divided into 3 groups, 30 cases in each group.Group A：the fentanyl group;Group B：the combined groups;Group C：the dezocine group .10 min before finish the surgery , 3 groups were analgesia intravenous analgesia pump liquid 5 ml as load, intravenous access surgery PCA pump into conscious extuba-tion.Analgesic solution preparation：A group dezocine 0.5 mg /kg, group B for fentanyl 10μg /kg, C group dezocine 0.25 mg /kg ＋fentanyl 5μg /kg for the land , in both groups of pumps were added with ondansetron 8 mg and saline formulated into a total of 100 ml, background infusion rate 2 ml /h, PCA volume 0.5 ml, lockout time 15 min.Using the VAS score and Ramsay score were evaluated after 2,6,12,24 and 48 h analgesia and sedation level;measured before anesthesia , 12,24,48 h serum concentrations of 5-HT and SP;recorded within 48 h after the occurrence of adverse reactions .Results Compared with the postoperative 2 h, after 24,48 h, VAS score and Ramsay score in three groups were decreased （ P 〈0.05）; and com-pared with group A and B, group C after 2,6,12,24 h＆#39;s Ramsay score was significantly higher （ P 〈0.05）.Compared with the previous anesthesia , patients in three groups 12,24,48 h＆#39;s serum 5-HT and PS concentration was increased （ P 〈0.05）;Compared with group A, group C after 12,24,48 h＆#39;s 5-HT and SP serum concentrations were significantly lower （ P 〈0.05）;compared with group B , group C＆#39;s 5-HT and SP concentrations were significantly decreased （ P 〈0 g.05 ） .Compared with group A and group B, group C＆#39;s nausea, vomiting, respiratory depression, dizziness occurred significantly reduced （group A of 16.7%, group B of 26.7%, group C of 6.7%, P 〈0.05）.Conclusion Dezocine combined with fentanyl on controlled intravenous analgesia joint replacement surgery can effectively relieve postoperative pain , suppress and SP after 5-HT concen-tration, poor reactions occur less than single usages , worthy of clinical application .