丙泊酚联合芬太尼在晚期癌痛患者鞘内药物输注系统植入手术的应用

Application of propofol combined with fentanyl during IDDS implantation surgery in patients with advanced cancer pain

目的探讨丙泊酚联合芬太尼在晚期癌痛患者行鞘内药物输注系统(IDDS)植入手术中镇静、镇痛的有效性及安全性。方法将40例晚期癌痛拟行IDDS手术的患者随机均分为丙泊酚联合芬太尼(P组)和单用芬太尼(F组)两组。手术开始前10min内,P组患者静脉泵入丙泊酚2mg/kg;手术开始后持续泵注丙泊酚1.5mg·kg^(-1)·h^(-1)并适时调整剂量,以维持患者Ramsay镇静评分3～4分,直至手术结束。F组泵入等容量生理盐水作对照。术前5min所有患者静脉注射芬太尼1μg/kg。术中根据患者VAS疼痛评分,间断追加芬太尼。记录入室时(T0)、手术开始时(T1)、手术15、30、45、60、75和90min(T2～T7)、术毕(T8)、入麻醉后恢复室15min(T9)和30min(T10)时的MAP、HR、SpO_2、VAS疼痛评分以及Ramsay镇静评分。计算芬太尼用量和患者完全恢复时间,记录患者并发症发生情况以及满意度评分。结果与F组相比,P组在T1～T4时MAP降低,Ramsay镇静评分在T1～T9时升高,患者满意度评分增加,但低血压发生率升高(P<0.05)。结论丙泊酚联合芬太尼可安全用于晚期癌痛患者IDDS手术,具有良好的镇静、镇痛作用,但易引起BP下降,需注意防治。

Objective To explore the efficacy and safety of propofol combined with fentanyl in sedation and analgesia during implantation of intrathecal drug infusion system(IDDS)for the patients with advanced cancer pain.Methods Forty patients with advanced cancer pain scheduled for IDDS implantation were randomly and equally assigned into two groups.The patients in group P were infused propofol in a loading dose of 2 mg/kg within 10 minutes before operation,which was followed by infusion of propofol 1.5 mg·kg-1·h-1or so to maintain Ramsay score of 3-4 points until the end of surgery.The patients in group F were infused equal volume of normal saline as the controls.All patients received injection of fentanyl 1μg/kg intravenously at 5 minutes before operation.During operation,fentanyl was intermittently injected according to patients’ VAS pain score.The MAP,HR,SpO2,VAS pain score and Ramsay sedation score were evaluated after entering operation room(T0),at the begining of operation(T1),at 15,30,45,60,75 and 90 minutes during operation(T2-T7),at the end of operation(T8),at 15 minutes and 30 minutes after arrival at PACU(T9 and T10).The consumption of fentanyl and the time for full recovery were calculated.The incidence of adverse responses and satisfaction score of the patients were recorded as well.Results Compared with group F,group P had a signifcantly lower MAP at T1 to T4(P<0.05),higher Ramsay sedation score at T1 to T9(P<0.05),higher satisfaction score but higher incidence of hypotension(P<0.05).Conclusion Combined use of propofol and fentanyl can be safely used for IDDS implantation surgery in the patients with advanced cancer pain,which can achieve better sedation and analgesic effect.However,more attention should be paid to the prevention and treatment of hypotension during propofol infusion.