耳鼻咽喉头颈外科患者术后镇痛调查分析

Investigation of postoperative analgesia in patients undergoing ENT procedures

目的探讨耳鼻咽喉头颈外科不同手术患者术后镇痛的效果和不良反应。方法选择2013年5月～2014年8月行中耳手术（E组）、鼻内镜手术（N组）、喉切除＋颈淋巴结清扫术（T组）的患者。所有患者使用统一的术后镇痛配方。术后24h调查最高视觉模拟量表（visualanaloguescale，VAS）评分、追加舒芬太尼的次数、睡眠、情绪、恶心呕吐、眩晕等。结果三组VAS评分无统计学差异，均无追加舒芬太尼。N组夜间醒来的患者明显增多（Z2=281．798，P〈0．01），而N组和T组情绪改变的患者明显增多（x2=123．408，P〈0．01）。E组恶心（x2=144．895，P〈0．01）和眩晕（x2=175．709，P〈0．01）发生率明显增高，而呕吐发生率高于N组（x2=7．524，P=0．023）。结论舒芬太尼1μg／kg＋凯纷3mg／kg能为耳鼻咽喉头颈外科患者提供满意的术后镇痛，不同的手术患者术后睡眠、情绪、不良反应不同，应采取个体化的心理和药物治疗。

OBJECTIVE To investigate the effects and adverse reaction in patients received postoperative analgesia after ENT procedures. METHODS Patients scheduled to receive elective middle ear （E）, endoscopic sinus surgery （N） and laryngectomy （T） during the period from May 2013 to August 2014 received general anesthesia and uniform postoperative analgesia. Visual analogue scale （VAS）, additional Sulfentanyl administration, waking up during nocturnal sleep, mood change, post-operative nausea and vomiting and dizzy were recorded in 24 h post- operatively. RESULTS There was no difference among three groups for VAS and no more Sulfentanyl needed. There were higher frequency of waking up during nocturnal sleep in group E than that in other groups （Z2=281.798, P〈0.01）, more bad mood in group E and T （Z2=123.408, P〈0.01）. The frequency of nausea （Z2=144.895, P〈0.01） and dizzy （X：=175.709, P〈0.0I） in group E were higher than that of other two groups, vomiting in group E was higher than group N （Z2=7.524, P=0.023）. CONCLUSION Sulfentanyl 1 ~tg/kg and flurbiprofenaxetil 3 mg/kg could provide satisfactory postoperative analgesia for patients undergoing ear, nose and throat procedures. Different types of procedure may result in different effects on nocturnal sleep, mood changes and adverse reaction. Individualized medication and psychological intervention should be made to improve sleep and mood, reduce adverse reactions for different patients.