不同芬太尼背景剂量PCSA疗效比较

Comparison of Effect of PCSA with Various Backgroud Dose of Fentanyl

目的探讨术后患者皮下自控镇痛(PCSA)合理、安全有效的参数设置,为PCSA推广提供依据。方法选择AsA Ⅰ～Ⅲ级、年龄20～65岁、欲在全麻下行腹部手术的患者100例,根据芬太尼背景用药量的不同将患者随机分为:1.2(Ⅰ组)、1.0(Ⅱ组)、0.8(Ⅲ组)、0.6(Ⅳ组)、0.4μ(Kg·h)(Ⅴ组)5组,每组PCA单次芬太尼剂量为0.4μg/kg,锁定时间为10 min。用双盲法对各组镇痛后2、6、12、24 h时点的VRS评分,镇静评分,皮肤瘙痒,恶心、呕吐发生率,血压、心率、呼吸、脉氧饱和度(吸O2 3 L/min)和术后24 h芬太尼总量、背景用药芬太尼总量、PCA芬太尼总量和PCA次数进行效果评价。结果 Ⅰ、Ⅱ组在镇痛后备时间点的VRS评分低于Ⅲ～Ⅴ组,其中镇痛后6、12、24 h,Ⅰ组、Ⅱ组与Ⅴ组比较差异显著(P<0.05);镇痛后24 h组Ⅰ的镇静评分为2.94±0.24分,明显高于Ⅲ组(2.47±0.48)、Ⅳ(2.31±0.74)、Ⅴ组(2.23±0.43)(P<0.05),Ⅱ组的镇静评分(2.62±0.49)也高于Ⅴ组(P<0.05);各组皮肤瘙痒,恶心、呕吐发生率和对肠蠕动恢复时间、血流动力学的影响无差异(P>0.05);在吸氧下(3L/min)镇痛后24 h Ⅰ组呼吸频率和指脉氧饱和度明显低于Ⅲ～Ⅴ组(P<0.05)。镇痛后24 h芬太尼总量及背景芬太尼总量Ⅰ组>Ⅱ组>Ⅲ组>Ⅳ组>Ⅴ组,PCA芬太尼总量及PCA按压次数Ⅰ组<Ⅱ?

Objective To explore a effective and safe parameter setting for patient-controlled subcutaneous analgesia (PCSA). Methods 100 patients (ASA 1-Ⅲ) at ages from 20 to 65 undergoing abdominal operations were enrolled in series and were randomly divided into 5 groups according to various backgroud dose of fentanyl: 1. 2 μg/( kg . h) (Group Ⅰ ),1.0 μg/(kg.h) (Group Ⅱ) ,0.8 μg/(kg.h) (Group Ⅲ),0.6μg/(kg.h) (Group Ⅳ),0.4 μg/(kg.h) (Group Ⅴ). In each group, the single dose of fentanyl for PCA was 0.4μg/kg each time and the lockout time was 10 minutes. It was a randomized,doubled-blinded and controlled trial to assess the outcome of each group. The index for evaluation included the value of analgesia and sedation, the incidence of pruritic skin, the incidence of nausea and vomiting,blood pressure, heart rate,SpO2(O2 3 L/min) and the rate of breath at each point of 2,6,12 and 24 hours after PCSA. The total SpO2 amount of fentanyl, the total amount of background dose of fentanyl, the total amount of fentanyl for PCA and the times of PCA within 24 hours after PCSA were calculated for each group. Results At the point of 6,12 and 24 hours after PCSA, the value of analgesia in group Ⅰ and group Ⅱ was significantly lower than that in group V (P<0.05), However,at the 24 th hour after PCSA,the value of sedation in group Ⅰ was significantly higher than that in group Ⅲ , Ⅳ ,Ⅴ and the value in group Ⅱ was also significantly higher than that in group Ⅴ (P<0.05) ; There was no significant difference about the incidence of pruritic skin, the incidence of nausea and vomiting,blood pressure,heart rate and the time of recovery of intestinal peristalsis in each group (P >0.05). At the point of time of 24 hours after PCSA, the rates of breath and SpO2 (O2 3 L/min) in group Ⅰwas significantly lower than those in group Ⅲ , Ⅳ andⅤ (P < 0. 05). Within 24 hours after PCSA, the total amount of fentanyl and the total amount of background dose of fentanyl was:group Ⅰ>Ⅱ>Ⅲ>Ⅳ>Ⅴ; the total amount of fentanyl for PCA and the times of PCA was: group Ⅰ<Ⅱ<Ⅲ<Ⅳ<Ⅴ. Conclusion The group Ⅲ and Ⅳ can provide reliable analgesia,moderate sedation and less respiratory depression and are both recommendable. However, the group Ⅳ is optimal because of the less total dose of fentanyl needed.