酮咯酸氨丁三醇联合舒芬太尼在腹腔镜胆囊切除术静脉自控镇痛中的临床应用

Clinical application of ketorolac tromethamine combined with sufentanil for patient-controlled intravenous analgesia after laparoscopic cholecystectomy

目的:探讨酮咯酸氨丁三醇联合舒芬太尼用于腹腔镜胆囊切除术(LC)后静脉自控镇痛的有效性及安全性。方法:按照随机数字表法将60例患者分为观察组(使用酮咯酸氨丁三醇联合舒芬太尼镇痛)与对照组(单纯采用舒芬太尼镇痛),每组30例。记录两组开始镇痛后1 h、2 h、4 h、8 h、12 h、24 h、48 h的疼痛程度,以视觉模拟评分(VAS)表示;对两组患者术后镇痛效果的满意度进行评价;记录两组患者术后48 h舒芬太尼用量及镇痛期间不良反应(恶心、呕吐、呼吸抑制、嗜睡、异常出血等)的发生情况。结果:术后1 h、2 h、4 h、8 h、12 h、24 h、48 h,两组VAS评分差异无统计学意义(P>0.05);观察组镇痛效果满意度高于对照组(P≤0.01);术后48 h,观察组舒芬太尼用量少于对照组;观察组不良反应发生率低于对照组,差异有统计学意义(P≤0.01)。两组均未出现呼吸抑制、异常出血。结论:酮咯酸氨丁三醇联合舒芬太尼用于LC后静脉自控镇痛,可显著减少单纯应用舒芬太尼所带来的不良反应,从而提高术后镇痛的安全性与舒适性。

Objective:To investigate the efficacy and safety of ketorolac tromethamine combined with sufentanil for patient-controlled intravenous analgesia after laparoscopic cholecystectomy(LC).Methods:According to the random number table method,60 LC patients were divided into observation group(ketorolac tromethamine combined with sufentanil analgesia group)and control group(simple sufentanil analgesia group),30 cases in each group.The degree of pain was observed and recorded at 1 h,2 h,4 h,8 h,12 h,24 h and 48 h after the onset of analgesia in the two groups,expressed by visual analogue scale(VAS);the satisfaction of the two groups was evaluated for the effect of postoperative analgesia;the dosage of sufentanil 48 hours after operation and the occurrence of adverse reactions(nausea,vomiting,respiratory depression,sleepiness,abnormal bleeding,etc.)during analgesia were recorded.Results:There was no significant difference in VAS scores between the two groups at 1 h,2 h,4 h,8 h,12 h,24 h and 48 h after operation(P>0.05);the satisfaction of analgesic effect in the observation group was significantly higher than that in the control group(P<0.01);the dosage of sufentanil in the observation group was significantly less than that in the control group at 48 h after operation;the incidence of adverse reactions in the observation group was significantly lower than that in the control group,with significant difference(P<0.01).There were no respiratory depression or abnormal bleeding in both groups.Conclusions:Ketorolac tromethamine combined with sufentanil for laparoscopic cholecystectomy patient-controlled intravenous analgesia can significantly reduce the adverse reactions caused by sufentanil alone,thus improve the safety and comfort of postoperative analgesia.