酮咯酸氨丁三醇联合舒芬太尼用于直肠癌根治术术后镇痛的研究

Effect of ketorolac tromethamine being used on patients who undergo radical resection of rectal carcinoma along with sufentanil

目的观察酮咯酸氨丁三醇联合舒芬太尼用于直肠癌根治术术后镇痛的效果及安全性。方法选择择期行直肠癌根治术的患者40例。将患者随机分为A、B 2组,每组20例。常规全麻诱导和维持,术闭拔管后,分别连接含有不同药物的静脉自控镇痛(PCIA)泵。A组PCIA泵内应用舒芬太尼1.5μg/kg,酮咯酸氨丁三醇3.0mg/kg,雷莫司琼0.6mg;B组:舒芬太尼2.5μg/kg,雷莫司琼0.6mg,为对照组。记录启动PCIA泵即刻(T0)、1h(T1)、2h(T2)、4h(T3)、8h(T4)、12h(T5)、24h(T6)36h(T7)、48h(T8)的视觉模拟疼痛(VAS)评分、镇静评分(Ramsay评分)、血压(BP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)的变化及术后镇痛期间恶心、呕吐、呼吸抑制、嗜睡、异常出血等副作用的发生情况,另外比较2组PCIA泵按压次数。结果 (1)疼痛评分2组患者T1、T2时刻VAS评分较T0有所增高,但无统计学意义(P>0.05),T3-T8VAS呈平稳降低趋势;组间比较无差异(P>0.05)。(2)镇静评分A组患者在T1-T8时间点镇静评分无差异(P>0.05),B组在T2、T3、T4时刻的镇静评分比A组相应数据显著升高(P<0.05)。(3)PCIA泵按压次数A、B组各时间点数据无差异(P>0.05)。(4)副作用发生频率B组较A组术后恶心、嗜睡的发生率显著升高(P<0.01)。结论直肠癌根治术后应用舒芬太尼1.5μg/kg,酮咯酸氨丁三醇3.0mg/kg配制的PCIA泵进行镇痛,既能达到理想镇痛效果,又能有效减少不良反应的发生。

Objective To observe the safety and the effect of ketorolac tromethamine along with sufentanil as a postoperative patient-controlled intravenous analgesia,which is used by the patients who undergo a radical resection of rectal carcinoma.Methods A total of 40 patients undergoing a radical resection of rectal carcinoma were randomly divided into two groups,20 cases in each.Group A use a PCIA with sufentanil 1.5 μg/kg,ketorolac tromethamine 3.0 mg/kg, ramosetron 0.6 mg after sugery;and Group B use a PCIA with sufentanil 2.5 μg/kg,ramosetron 0.6 mg.Start the PCIA instantly when the patient awake.Record the blood pressure（BP）,heart rate（HR）,respiratory rate（RR）,pulse oxygen saturation（SpO2 ）,and side effects,such as nausea,vomiting,respiratory inhibition,bleeding at the following moments：instantly（T0 ）,1 h（T1 ）,2 h（T2 ）,4 h（T3 ）,8 h（T4 ）,12 h（T5 ）,24 h（T6 ）,36 h（T7 ）,48 h（T8 ）after the operation.Record the intensity of pain using the VAS,the intensity of sedation using Ramsay.Count the numbers of pressing.Results （1）VAS scores：the scores at T1 and T2 were higher than the scores at T0 in Group A and Group B,but there is no significant difference,then after the T2 the scores were lower and lower;there is no significant difference between Group A and B（P 〉0.05）.（2）Intensity of sedation：the scores of Group B at T2 ,T3 ,T4 were higher than Group A（P 〈0.05）.（3）Incidence of side effects：incidences of nausea and drowsiness are higher in Group B than Group A（P〈0.05）.Vomiting,respiratory inhibition and bleeding don’t happen to all patients.（4）Times of pressing：there is no difference between Group A and B（P 〉0.05）.Conclusion Using PCIA with ketorolac tromethamine 3.0 mg/kg and sufentanil 1.5 μg/kg has great analgesia effect and less side effects after a radical resection of rectal carcinoma.