舒芬太尼不同给药方式镇痛在膝关节手术的应用

Application of sufentanil analgesia with different ways of drug delivery affter knee surgery

目的探讨舒芬太尼不同给药方式对膝关节镜手术术后镇痛效果的影响。方法选取我院拟行膝关节镜手术患者120例,随机分成4组(每组30例),未使用镇痛组(A组)、舒芬太尼持续静脉镇痛(PCIA)组(B组)、舒芬太尼膝关节腔内注射组(C组)、舒芬太尼PCIA+膝关节腔内注射复合组(D组)。分别记录术后6、12、24、48h各时点静息和运动状态下各组的VAS评分,记录术后镇痛泵按压追加的次数和双氯芬酸钠的使用情况;记录术后6、12、24、48h各时点患者的意识状态、血压、心率和SPO_2;记录术后不良反应发生情况。结果与A组比较,B、C、D三组的静息和运动VAS评分均降低;与C组比较,B、D两组的静息和运动VAS评分均明显降低,其中D组的静息和运动VAS评分最低。与B、D组比较,C组肌肉注射双氯芬酸钠的使用量增加;与C组比较,A组双氯芬酸钠的使用量明显增加;与B组比较,D组PCA按压次数明显减少。与A、C、D组比较,B组恶心呕吐、皮肤瘙痒不良反应发生率均显著升高。四组患者术后各时点均意识清楚,监测血压、心率、SPO_2均无明显差异性变化。结论舒芬太尼关节腔内注射能显著缓解膝关节镜手术患者术后疼痛,可明显降低静脉舒芬太尼注射剂量及其他止痛药物使用量,从而降低不良反应发生率,促进患者快速康复。

Objective To explore the effect of sufentanil analgesia with different ways of drug delivery affter knee arthroscopic surgery. Methods 120 patients undergoing knee arthroscopic surgery were randomly divided into 4 groups（30 cases in each group）.Group A：No analgesic used. Group B：Sufentanil postoperative continuous intravenous analgesia（PCIA）. Group C：Sufentanil injected in the knee cavity. Group D：The joint of sufentanil PCIA and sufentanil injected in the knee cavity. We recorded the Visual Analogue Scale（VAS） scores measured in rest and activity at 6,12,24,and 48h after surgery;the time of postoperative PCIA pump and the use of diclofenac sodium;the state of consciousness,blood pressure,heart rate and SPO_2 at 6,12,24 and 48h after surgery;Situation of postoperative adverse reactions. Results Compared with group A,the VAS scores at rest and activity were significantly decreased of group B,C and D. Compared with group C,the VAS scores at rest and activity were decreased of group B and D. Among them,the lowest was group D. Compared with group B and D,the use of diclofenac sodium increased in group C.Compared with group C,the use of diclofenac sodium increased in group A. Compared with group B,the time of postoperative PCIA pump were significantly decreased in group D. Compared with group A,C and D,the incidence of nausea,vomiting and itching were significantly increased in group B. The four groups of patients were fully conscious and no significant difference in blood pressure,heart rate and SPO_2 at all times after surgery. Conclusion The analgesia method of sufentanil injected in the knee cavity can significantly relief postoperative pain,reduce doses of sufentanil or other painkillers,reduce the incidence of adverse reactions in patients affter knee arthroscopic surgery. It ultimately promote patients quickly recovery after surgery.