瑞芬太尼用于骨科术中及术后静脉镇痛的效果观察

Analgesia effects of remifentanil for intraoperative and postoperative of orthopaedic surgery

目的：观察瑞芬太尼用于骨科手术术中及术后静脉镇痛的效果。方法：选择择期在全身麻醉下行骨科手术患者80例均采用气管插管全凭静脉麻醉,术后行自控静脉镇痛。患者随机分为瑞芬太尼组（A组）和分太尼组（B组）,每组40例。术中麻醉维持,A组：丙泊酚5 mg/（kg·h）泵注,瑞芬太尼0.15μg/（kg·min）泵注,维库溴铵2~4 mg/h;B组：丙泊酚5 mg/（kg·h）泵注,芬太尼2μg/kg/h泵注,维库溴铵2~4 mg/h。术后自控静脉镇痛配方为A组：瑞芬太尼1mg＋托烷司琼5mg加生理盐水至100 ml,B组：芬太尼1 mg＋托烷司琼5 mg加生理盐水至100 ml。观察并记录两组患者术后12、24 h PCA总按压次数和有效按压次数,1、3、6、12、24 h NRS和BCS评分,观察有无恶心呕吐、畏寒发热、头晕、嗜睡等不良反应。结果：A组术后12和24 h PCA总按压次数和PCA有效按压次数与B组比较均明显降低（P〈0.05）;A组术后3 h、6 h、12 h和24 h的NRS评分明显较低,而BCS评分明显偏高（P〈0.05）;两者间恶心呕吐、畏寒发热、头晕、嗜睡等不良反应发生率差异均无统计学意义（P〉0.05）。结论：瑞芬太尼用于骨科术中和术后镇痛效果明显,是一种骨科手术术中和术后有效而安全的镇痛药物。

Objective To evaluate the analgesia effects of remifentanil for intraoperative and postoperative of orthopaedic surgery. Method 80 patients with upper abdominal surgery were randomly divided into remifentanil group （ group A ） and sufentanil group （group B） ,40 cases in each group. Intraoperative anesthesia, group A：propofol 5 mg/（ kg · h） pump injection, remifentanil 0. 15 μg/（ kg · min） pump injection,vecuronium bromide 2 -4 mg/h;group B： propofol 5 mg/（kg · h） pump injection,fentanyl 2 μg/（kg ·h） pump injection, vecuronium bromide 2 - 4 mg/h. Patient controlled intraveous analgesia gradients used for group A and Group B was remifentanil 1 mg ＋ tropisetron hydrochloride 5 mg;propofol 1 mg ＋ tropisetron hydrochloride 5 mg;which were diluted to be 100 mL by adding sa-ine. NRS, BCS scores and pressing times of PCA equipment, side effects were recorded and compared; Results PCA the number of total pressure and the number of effective pressure of group A, 12 hours and 24 hours after operation were significantly decrease than group B （P 〈 0. 05 ） ; NRS scores of group A, 3,6,12 and 24 h after operation were significantly decrease than group B （ P 〈 O. 05 ） ; BCS scores of group A ,3,6,12 and 24 h after operation were significantly increase than group B （P 〈 0.05 ） ;The incidence of adverse reactions include nausea and vomiting,chills, fever, dizziness, sleepiness and so on between the two groups, were no statistically significant difference （P 〉 0. 05 ） ; Conclusion The analgesia effect of remifentanil is obvious, remifentanil is an effective and safe analgesic drugs for intt＇aoperative and postoperative of orthopaedic surgery.