摘要
目的比较等效剂量国产舒芬太尼和芬太尼复合盐酸奈福泮用于下肢骨科手术患者静脉自控镇痛（PCIA）的效果及不良反应。方法选择ASAⅠ，Ⅱ级，年龄20～60岁，择期全麻下肢骨科手术患者60例，随机分为舒芬太尼组（S组）和芬太尼组（F组）各30例。术毕即接电子泵行PCIA。S组：舒芬太尼100μg、奈福泮100mg、格拉斯琼3mg、生理盐水稀释至100ml；F组：芬太尼1mg、奈福泮100mg、格拉斯琼3mg、生理盐水稀释至100ml。背景剂量1．5ml／h，PCA剂量1.0ml，锁定时间15min。记录术后4，12，24，48h的血压、心率、呼吸频率、SpO2；静息及活动时的疼痛评分（VAS法）；镇痛、恶心、呕吐评分及尿潴留、皮肤瘙瘁、呼吸抑制等不良反应的发生情况；记录患者PCA总按压次数；记录患者镇痛满意评分及其它镇痛药物的情况及其剂量和次数。结果术后血压、心率、呼吸频率、SpO2在两组比较差异无统计学意义（P〉0．05）。S组术后4，12，24，48h的VAS评分均明显低于F组（P〈0．01）。镇静评分在两组间比较差异无统计学意义（P〉0．05）。S组术后恶心及呕吐者明显少于F组（P〈0．05）。术后4，12，24h时间点S组的按压次数明显少于F组（P〈0．05）。S组术后镇痛满意度评分明显优于F组（P〈0．05）。结论国产舒芬太尼复合奈福沣用于下肢骨科手术静脉自控镇痛，其效果优于芬太尼复合奈福沣静脉自控镇痛，无明显不良反应。
Objective To evaluate the efficacy and safety of sulfentanlyl-nefopam and fentanyl-netopam for patient-controlled intravenous analgesia（PCIA）after lower limb surgery with general anesthesia. Methods 60 ASA grade Ⅰ,Ⅱ patients aged 20 - 60 undergoing lower limb surgery with general aneathesia were randomly divided into two groups ：sufentanil-nefopam（ S , n = 30）versus fentanil-nefopam（ F , n = 30）. The patients in group S received 1μg/ml sufentanil, 1 mg/ml nefopam plus 30 μg/ml granisetron, with a total volume of 100 ml,in group F 10μg/ml fentanyl, 1mg/ml nefopam plus 30μg/ml granisetron. PCIA parameters were a bolus dose of 1.0ml,loekout time of 15 minutes and continuous infusion of 1.5ml/h. Vital signs including MAP,HR, RR,SpO2,the pain intensity according to visual analogue scalc（VAS）at rest and during mobilization,satisfaction,sedation scores and side effects such as nausea,vomiting,urine retention,pruritus, breath depression were recorded at 4, 12,24 and 48h postoperatively; the total number of PCA and other analgesics were be recorded.Results The tv,o groups were comparable with respect to demographic data,duration of surgery and duration of anesthesia.There were no differenee of MAP,HR,RR, SpO2 between the two groups. The VAS scores at rest and during mobilization was lower in groups S than in group F（ P 〈 0.01 ） . No significant difference was observed in sedation scores between the two groups. The total number of PCA in group F was more than that in group S（ P 〈 0.05） .The scores of satisfaction of postoperative analgesia was lower in group F than in group S（ P 〈 0.05） .The incidence of nausea or vomiting in group S was lower than that in group F（ P 〈 0.05）. Conclusion PCIA with sufentanyl-nefopam provides better efficacy of analgesia with lower incidence of nausea and vomiting than with fentanyl-nefopam in postoperative patients with lower llmb surgery.
出处
《四川医学》
CAS
2008年第3期280-282,共3页
Sichuan Medical Journal
关键词
舒芬太尼
芬太尼
奈福泮
静脉自控镇痛
sufentanil
fentanil
nefopam
patient-eontrolled intravenous analgesia
