有或无背景剂量患者自控静脉镇痛对腹腔镜结直肠癌术后镇痛效果的影响

Effects of postoperative PCIA with or without background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopic colorectal cancer operation

目的观察有或无背景剂量地佐辛复合氟比洛芬酯患者自控静脉镇痛(PCIA)对腹腔镜结直肠癌手术术后镇痛效果的影响。方法纳入结直肠癌患者60例,术后行PCIA,药物配方均为地佐辛0.6 mg/kg+氟比洛芬酯3 mg/kg+生理盐水至120 m L。随机分为两组:常规背景剂量组(CB组)和无背景剂量组(NB组)。术后观察48 h。记录术后各时间点NRS评分、Ramsay镇静评分,镇痛泵按压次数和镇痛药物累积消耗量,术后补救镇痛及不良反应发生情况,首次下床活动时间,首次排气时间和镇痛总体满意度。对首次下床活动时间和首次排气时间的影响因素进行分析。结果与CB组比较,NB组患者术后各时点NRS评分均显著升高(P<0.05),术后24和48 h时Ramsay镇静评分显著降低(P<0.05),镇痛泵按压次数显著增加(P<0.05),补救镇痛次数显著增加(P<0.05),术后24和48 h镇痛药物累积消耗量显著降低(P<0.05),术后首次下床活动时间显著延长(P<0.05),满意度显著降低(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。首次下床活动时间与术后24 h活动NRS评分和性别显著相关(P<0.05);首次排气时间与BMI、术中补液量和年龄显著相关(P<0.05)。结论地佐辛复合氟比洛芬酯用于腹腔镜下结直肠癌手术术后镇痛,有背景剂量PCIA镇痛效果好,更适用于术后镇痛。

Objective To compare the effectiveness of patient-controlled intravenous analgesia with orwithout background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopiccolorectal cancer operation. Methods Sixty patients scheduled for laparoscopic colorectal cancer surgery,35 males and 25 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups：common-dose background infusion group（Group CB,n = 30）,and no background infusion group（Group NB,n = 30）. All patients were intravenously administered a PCA pump containing dezocine 0.6 mg/kg,flurbiprofenaxetil 3 mg/kg and normal saline in a volume of 120 mL. Patients in Group CB were given background infusion rateof 2 mL/h with PCA bolus dose 2 mL,patients in Group NB were given PCA bolus dose 4 mL only. NRS scores,Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,incidence of ad-verse reactions,time of first exhaust,time of first leaving bed and patients＇ satisfaction scores were recorded aftersurgery. The influence factors of time of first exhaust and time of first leaving bed were also analyzed. Results Compared with group CB,the NRS scores in group NB were higher both at rest and during movement（P〈0.05）,the Ramsay sedation scores in group NB were lower at 24 and 48 h after surgery（P〈0.05）,the pressing times ingroup NB were higher（P〈0.05）,the consumption of analgesic in group NB were lower after surgery,and theincidence of using supplementary analgesics was higher（P〈0.05）. No statistical difference was found on the in-cidence of adverse reactions between the two groups（P〉0.05）. Moreover,the time of first leaving bed in groupNB was longer than that in group CB（P〈0.05）. The satisfaction scores in group NB was lower than that in groupCB（P〈0.05）. The main influence factors of the time of first leaving bed were gender and NRS score during move-ment at 24 h after the operation（P〈0.05）. The main influence factors of the time of first exhaust were age,BMIand fluid infusion volume（P〈0.05）. Conclusion Postoperative patient-controlled intravenous analgesia withbackground infusion of dezocine and flurbiprofen axetil injection was more efficacious and satisfactory,and moresuitable in postoperative pain management.