肛瘘患者术后应用酮咯酸氨丁三醇镇痛对疼痛、生命体征和Ramsay评分的影响

Effects of Ketorolac Tromethamine in Postoperative Analgesia for Patients after Anal Fistula Operation on Pain,Vital Signs and Ramsay Score

目的探讨肛瘘患者术后应用酮咯酸氨丁三醇镇痛对疼痛、生命体征和Ramsay评分的影响。方法选择2015年5月—2016年4月进行择期肛瘘切除术的患者80例,根据镇痛方法分为曲马多组和酮咯酸氨丁三醇组,每组40例。两组均在术毕患者清醒后采用自控镇痛泵,曲马多组泵内应用曲马多,酮咯酸氨丁三醇组泵内应用酮咯酸氨丁三醇。根据视觉模拟疼痛(VAS)评分观察启动自控镇痛泵即刻(T0)、1 h(T1)、4 h(T2)、8 h(T3)、12(T4)、24 h(T5)、36 h(T6)、48 h(T7)疼痛强度、疼痛强度差、疼痛缓解度的变化;观察患者自控镇痛后6、12、24、36 h脉搏氧饱和度、心率和平均动脉压变化及T1~T7时Ramsay评分的变化。结果两组中和重度疼痛患者T1~T7时VAS评分均低于T0(P<0.05)。两组重度疼痛患者T1~T7时VAS评分、疼痛强度差和疼痛缓解度组内比较差异有统计学意义(P<0.05)。T1时,酮咯酸氨丁三醇组重度疼痛患者VAS评分高于曲马多组(P<0.05)。两组自控镇痛后36 h心率和平均动脉压均高于6 h(P<0.05)。两组T6和T7时Ramsay评分均低于T1~T5(P<0.05),酮咯酸氨丁三醇组T7时Ramsay评分低于曲马多组(P<0.05)。结论肛瘘患者术后应用酮咯酸氨丁三醇,具有良好的镇痛效果,同时对心率、平均动脉压、脉搏氧饱和度无显著影响,有利于患者恢复和配合临床诊疗。

Objective To investigate effects of Ketorolac Tromethamine in postoperative analgesia for patients af- ter anal fistula operation on pain, vital signs and Ramsay score. Methods A total of 80 patients with elective resection of anal fistula during May 2015 and April 2016 were divided into Tramadol group and Ketorolac Trisamine group （n = 40 for each group） according to analgesia methods. All patients received self-control analgesia pump after having postoperative consciousness, and Tramadol was used in Tramadol group, and Ketorolac Trisamine was given in Ketorolac Trisamine group. Changes of pain intensity, pain interaural intensity differences and pain easement degree were observed at the time of using self-control analgesia pump （TO）, 1 h （T1）, 4 h （T2）, 8 h （T3）, 12 （T4）, 24 h （T5）, 36 h （T6） and48 h （T7） after patient-controlled analgesia were observed according to visual analogue scales （VAS） score. Changes of pulse oxygen saturation, heart rate and mean arterial pressure levels at 6, 12, 24, 36 h after patient-controlled analgesia, and Ramsay score changes at T1-T7 were observed. Results VAS scores at T1-T7 in medium and severe patients were signifi- cantly lower than those at TO in two groups （P 〈 0. 05）. There were significant differences in VAS scores, pain interaural intensity differences and pain easement degree at T1-T7 in patients with severe pain in each group （ P 〈 0. 05 ）. At T1, VAS score of patients with severe pain in Ketorolac Trisamine group was significantly higher than that in Tramadol group （P 〈 0. 05）. In two groups, values of heart rate and mean arterial pressure at 36 h after patient-controlled analgesia were significantly higher than those at 6 h after patient-controlled analgesia （P 〈 0. 05 ） ; Ramsay scores at T6 and T7 were signif- icantly lower than those at T1-T5 （ P 〈 0.05 ）, while Ramsay score at T7 in Ketorolac Tromethamine group was significantly lower than that in Trisamine group （P 〈 0. 05）. Conclusion Ketorolac Tromethamine in postoperative analgesia for pa- tients after anal fistula operation can achieve good analgesic effect without significant effect on heart rate, mean arterial pressure or pulse oxygen saturation, and it is benefit to patients＇recover and cooperate with clinical treatments.