小剂量纳美芬复合舒芬太尼在老年患者术后静脉自控镇痛中的临床观察

Clinical observation of low-dose nalmefene combined with sufentanial for postoperative patients-controlled intravenous analgesia in elderly patients

目的观察小剂量盐酸纳美芬复合舒芬太尼用于老年患者术后静脉自控镇痛的有效性和安全性以及对不良反应的影响。方法选取90例择期行腹腔镜下胃癌根治术的老年患者,美国麻醉医师学会(ASA)Ⅱ~Ⅲ级。采用随机数字表法将患者分为S组、N1组和N2组,每组30例。S组镇痛泵配方为:舒芬太尼2μg/kg;N1组:舒芬太尼2μg/kg+纳美芬0.25μg/kg;N2组:舒芬太尼2μg/kg+纳美芬0.5μg/kg,均用生理盐水稀释至100 ml。由不知分组情况的另一位麻醉医生随访患者:(1)分别于术后2 h、6 h、12 h、24 h、36 h、48 h记录下列指标:疼痛视觉模拟评分(VAS)、Ramsay评分及不良反应的发生情况,两组患者48 h镇痛泵的有效按压次数。结果三组患者术后镇痛期间生命体征平稳,均取得了满意的镇痛效果,三组不同时点VAS评分、Ramsay评分、48 h镇痛泵有效按压次数组间比较无显著差异(P>0.05);与S组比较,N1组、N2组恶心、呕吐、呼吸抑制的发生率较低(P<0.05),但N1组与N2组比较无显著差异(P>0.05);三组头晕、皮肤瘙痒发生的例数组间比较无显著差异(P>0.05)。结论小剂量纳美芬复合舒芬太尼应用于老年患者术后静脉自控镇痛能达到满意的镇痛效果,并且可以降低恶心、呕吐、呼吸抑制等不良反应的发生,提高术后镇痛的安全性。

Objective To observe the effects and safety of low - dose nalmefene on the postperative analgesia and side effects of sufen-tanial for elderly patients. Methods Ninety elderly patients undergoing laparoscopy radical gastrectomy and given patients - controlled intravenous analgesia （PCIA）,were randomly divided into three groups with 30 cases in each group. Group S received sufentanial 2 μg/ kg,group N1 re-ceived sufentanial 2 μg/ kg ＋ nalmefene 0. 25 μg/ kg,group N2 received sufentanial 2 μg/ kg ＋ nalmefene 0. 5 μg/ kg,each group were diluted with saline water to 100 ml. Visual Analogue Scale,Ramsay score,and adverse effects,pressing times of PCA at 2 h,6 h,12 h,24 h,36 h,48 h after the operation were recorded respectively by another unwitting anesthetist. Results During the course of analgesia,the vital signs of three groups were stable. The pain scores,Ramsay scores and pressing times of PCA in 48 h were not significantly different among the three groups. Compared with group S,the incidence of nausea,vomiting and respiratory depression was significantly different among the groups N1,N2 during the postoperative 48 h （P 〈 0. 05）. However,there were no significantly differences between groups N1,N2 （P 〉 0. 05）. There was no signifi-cantly differences of sufentanial - related dizziness and pruritus in all groups. Conclusion Low - dose nalmefene infusion can ruduce sufentanial induced side effects without reversing its analgesic,low - dose nalmefene conbined with sufentanial is safe and effective for postoperative patients -controlled intravenous analgesia in elderly patients undergoing laparoscopy radical gastrectomy.