地佐辛联合舒芬太尼应用于乳腺癌术后静脉自控镇痛的临床观察

Clinical Observation of Dezocine and Sufentanil Combination for PCIA after Breast Cancer Surgery

目的：观察地佐辛与舒芬太尼在乳腺癌术后静脉自控镇痛（PCIA）的临床效果，探索更安全有效的术后镇痛方法。方法：选取择期行乳腺癌根治手术的患者90例，ASAⅠ~Ⅱ级，均采用全身麻醉，术后行PCIA。按随机数字表法将患者分为A、B、C三组，每组各30例。A组仅采用地佐辛镇痛，B组仅采用舒芬太尼镇痛，C组采用地佐辛＋舒芬太尼联合镇痛。观察记录三组患者术后4、8、16、24、36、48 h 的疼痛评分（VAS），舒适度评分（BCS）以及观察恶心呕吐、头晕、皮肤瘙痒、尿潴留、呼吸抑制等不良反应的发生率。结果：术后各时间点A组的VAS评分高于B组和C组，差异均有统计学意义（P〈0.05）；A、B、C三组各时间点的BCS评分比较差异无统计学意义（P〉0.05）；B、C组的头晕发生率小于A组；B组的恶心呕吐、尿潴留、皮肤瘙痒和呼吸抑制的发生率高于A组和C组，其中恶心呕吐的比较差异有统计学意义（P〈0.05）。结论：地佐辛联合舒芬太尼用于乳腺癌术后PCIA，效果确切满意，不良反应发生率小，经济性价值高，值得临床应用。

Objective：To investigate the effect of patient-controlled intravenous analgesia（PCIA）of Dezocine and Sufentanil in the patients with breast cancer after their surgical therapy,and to find out the safer and more effective postoperative analgesia. Method：90 breast cancer patients with radical surgery were selected,ASAⅠ-Ⅱlevel,were performed under the general anesthesia,followed by PCIA. Patients were randomly divided into the group A,B,C, 30 cases for each group. The group A only administered Dezocine,the group B only administered Sufentanil,the group C administered both Dezocine and Sufentanil. Pain score（VAS）,comfort score（BCS）and the incidence of adverse reactions,which included nausea and vomiting,dizziness,skin itching,urinary retention,respiratory depression,were observed and assessed for postoperative 4,8,16,24,36 h and 48 h.Result：The VAS scores of the group A was higher than those of the group B and C at each time point for postoperation,and the differences were statistically significant （P〈0.05）;the differences of BCS scores of three groups at all time points had no statistical significance（P〉0.05）;the incidence of dizziness of both B and C group was less than the group A. The incidences of nausea and vomiting,urinary retention,itchy skin,and respiratory depression of the group B were higher than those of the group A and C,and the difference of nausea and vomiting had statistical significance（P〈0.05）.Conclusion：The combined application of Dezocine and Sufentanil for PCIA of postoperative breast cancer is worthy of clinically popularizing,because of the exact effect of analgesia,fewer incidence of adverse reactions and high economic value.