丁丙诺啡与吗啡用于术后静脉病人自控镇痛的随机双盲研究

A Double Blind Randomized Controlled Clinical Study of Intravenous Patient-controlled Analgesia with Buprenorphine vs Morphine in The Postoperative Patients

目的:评价丁丙诺啡用于妇科手术后病人自控镇痛(patient-controlled analgesia,PCA)的效应和安全性。方法:60例妇科开腹子宫切除术病人术后随机分为丁丙诺啡组(B组,n=30)和吗啡组(M组,n=30),接受PCA治疗。B组使用丁丙诺啡(每次0.03 mg),最大用量每天1.2 mg;M组使用吗啡(每次1 mg),最大用量每天40 mg。两组PCA药液中均加入氟哌啶4 mg。结果:丁丙诺啡组与吗啡组24 h总的疼痛缓解程度(totalpain relief,TPR)分别为16.9±5.9和22.2±7.4(P>0.05),两组病人24 h总的疼痛差值(sum of pain intensity differences,SPID)分别为46.5±22.0和40.0±19.1(P<0.01)。B组和M组恶心及呕吐的发生率无显著差别,分别为53.3％和50％。结论:丁丙诺啡用于妇科手术后静脉PCA的镇痛效应与吗啡相同,其恶心及呕吐的发生率接近于吗啡。

OBJECTIVE: To compare the analgesic efficacy and safety of intravenous (patient-controlled analgesia, PCA) with buprenorphine and with morphine in patients following gynecologic surgery. METHODS: Sixty patients undergoing abdominal hysterectomy were randomly into buprenorphine group (group B, n=30) and morphine group (group M, n = 30). Group B received PCA with droperidol (4 mg) and buprenorphine (0.03 mg each time, maximal dose 1.2mg over 24h). Group M received with droperidol (4 mg) and morphine (1 mg each time, maximal dose 40 mg over 24h). RESULTS: The total pain relief (TPR) of group B was lower than that of group M ( 16.9 ± 5.9 and 22.2 ± 7.4, P>0.05) and the sum of pain intensity differences (SPID) of group B was significantly higher than that of group M (46.5 ± 22.0 and 40.0 ± 19.1, P<0.01). The rates of nausea and vomiting in group B were near to that of group M (53.3% vs 50.0%, P>0.05). CONCLUSION: The study suggests that the efficacy of PCA with buprenorphine was comparable to that of morphine. The occurrences of nausea and vomiting caused by buprenorphine were similar to that caused by morphine.