地佐辛联合舒芬太尼在上腹部及髋关节置换术后镇痛的临床研究

Clinical study on dezocine and sufentanil for postoperative analgesia in upper-abdominal surgery or hip replacement surgery

目的观察地佐辛联合舒芬太尼在上腹部及髋关节手术术后的镇痛效果及不良反应,并探讨其潜在的机制。方法择期行上腹部或髋关节手术患者100例,ASAⅠ或Ⅱ级,随机数字法分为地佐辛0.6 mg/kg组(D组)、地佐辛0.3 mg/kg+舒芬太尼1 μg/kg组(DS1组)、地佐辛0.3 mg/kg+舒芬太尼1.5 μg/kg组(DS2组)和地佐辛0.3mg/kg+舒芬太尼2μg/kg组(DS3组),每组25例。所有患者接受全凭静脉麻醉,术中采用瑞芬太尼6~8 μg·kg-1·h-1镇痛,缝皮时停药后缓慢注射舒芬太尼5 μg。分别记录患者术后1 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、36 h(T6)、48 h(T7)安静与90°翻身运动时的疼痛VAS评分,Ramsay镇静评分,补救镇痛用药总量及例数,并记录患者不良反应等。结果与其他三组比较,DS1组药物使用总量和补救镇痛例数明显增多(P<0.05)。四组患者术后不同时点Ramsay镇静和运动时疼痛VAS评分比较差异无统计学意义。T1~T3时DS1组患者疼痛VAS评分明显高于DS3组(P<0.05)。DS3组恶心和出汗发生率明显高于其他三组(P<0.05),D组躁动发生率较高,其他不良反应发生率差异无统计学意义。结论地佐辛联合舒芬太尼可安全用于上腹部手术及髋关节手术术后镇痛,在地佐辛0.3 mg/kg联合舒芬太尼1.5 μg/kg时镇痛效果好且不良反应小。

Objective To investigate the effect of dezocine combined with sufentanil on postoperative analgesia and side effects in the upper-abdominal surgery and hip replacement surgery, and explore the potential mechanisms, Methods One hundred patients scheduled for selective upper-abdominal operation and hip replacement surgery were randomly divided into group dezocine （group D）, dezocine 0.3 mg/kg combined with sufentanil 1 μg/kg group（group DS1）, dezocine 0.3 mg/kg combined with sufentanil 1.5 μg/kg group（group DS2） and dezocine 0.3 mg/kg combined with sufentanil 2 μg/kg group（group DS3）. Analgesia was maintained by remifentanil 6-8 μg· kg^-1 · h 1 under total intravenous anesthesia. Patients were administered 5 μg sufentanil during sewing the skin. Visual Analogue Score （VAS） of both silence and 90° turn over situation, Ramsay score, and adverse effects at 1 h （T1）, 4 h （T2）, 8 h （T3）, 12 h （T4）, 24 h （T5）, 36 h （T6）, 48 h （T7） after the operation were recorded respectively. Results The total amount of sufentanil and dezocine of group DS1 group showed a significant higher than the other three groups （P〈0.05）. The VAS in silence of group DS1 were higher than group DS3 at T1-Ta （P^0.05）. There was no significant difference in VAS under 90° turn over situation. The side effect of group DS3 were higher than the other three groups （P〈 0.05）. Conclusion Dezocine combined with sufentanil for postoperative patient-controlled intravenous analgesia（PCIA） is effective and safe in patients undergoing upper-abdominal surgery and hip replace- ment surgery, and while dezocine 0. 3 mg/kg combined with sufentanil 1.5μg/kg, it has the best effect of postoperative analgesia and least side effects.