喷他佐辛与舒芬太尼对老年骨科患者术后自控镇痛的效果比较
|
摘要
目的探讨喷他佐辛和舒芬太尼用于老年骨科患者术后静脉自控镇痛(PCIA)的临床效果及不良反应发生情况。方法纳入择期行髋关节置换术的老年患者60例,根据术后镇痛用药,随机分为喷他佐辛组(P组)和舒芬太尼组(S组)。P组采用喷他佐辛120 mg,S组采用舒芬太尼0.15 mg,分别加雷莫司琼0.3 mg,地塞米松5 mg以及0.9%生理盐水至100 ml。镇痛泵设置:持续流量2 ml/h,单次按压追加剂量0.5 ml,锁定时间15 min。观察记录患者入室后及术后2、6、12、24及48 h的心率(HR),平均压(MAP),呼吸频率(RR)和氧饱和度(SpO_2);记录各时间点的视觉模拟评分法(VAS)评分和Ramesay镇静评分;记录术后不良反应。结果两组患者各时间点HR、MAP、RR、SpO_2检测结果组间比较差异无统计学意义(P> 0.05);两组患者VAS镇痛评分和Ramesay镇静评分组间比较差异无统计学意义(P> 0.05);P组和S组分别有1例和5例发生恶心呕吐,P组无皮肤瘙痒,S组有2例出现皮肤瘙痒。结论 120 mg喷他佐辛和0.15 mg舒芬太尼应用于老年骨科患者术后镇痛,均能取得较好的镇痛效果,但喷他佐辛的不良反应更少。
Objective To observe the 1 effect of pentazocine and sufentanil on the patient-controlled intravenous analgesia(PCIA) in elderly post orthopedic surgery.Methods Sixty elderly orthopedic surgery patients received PCIA were randomly divided into pentazocine group(P group) and sufentanil group(S group).The PCIA solution used in group P contained pentazocine 120 mg,ramosetron 0.3 mg and dexamethasone 5 mg in 100 ml of normal saline,and in group S contained sufentani l0.15 mg,ramosetron 0.3 mg and dexamethasone 5 mg in 100 ml of normal saline.The PCIA pump was setup with background infusion at a rate of 2 ml/h,a 0.5 ml bolus dose and a 15 min lockout interval.The heart rate(HR),meanarterial pressure(MAP),respiratory rate(RR) and pulse oxygen saturation(SpO2) were recorded before surgery and at 2,6,12,24 and 48 h after surgery.Visual analog scale score(VAS) and Ramsay sedation score were recorded at abovementioned time points.The development of adverse reactions such as nausea and vomiting,pruritus,respiratory depression,hypotension and bradycardia was recorded.Result There was no significant different in HR,MAP,RR and SpO2 at all time points between two groups(P>0.05).The VAS and Ramsay sedation score presented no significantly difference(P>0.05).One and five patients presented nausea and vomiting in P group and S group,respectively.Two cases of pruritus were reported in group S,while no pruritus was reported in group P.Conclusion Both pentazocine 120 mg and sufentanil 0.15 mg have similar analgesia efficacy and fewer adverse reactions in the PCIA in elderly post orthopedic surgery.
Objective To observe the 1 effect of pentazocine and sufentanil on the patient-controlled intravenous analgesia(PCIA) in elderly post orthopedic surgery.Methods Sixty elderly orthopedic surgery patients received PCIA were randomly divided into pentazocine group(P group) and sufentanil group(S group).The PCIA solution used in group P contained pentazocine 120 mg,ramosetron 0.3 mg and dexamethasone 5 mg in 100 ml of normal saline,and in group S contained sufentani l0.15 mg,ramosetron 0.3 mg and dexamethasone 5 mg in 100 ml of normal saline.The PCIA pump was setup with background infusion at a rate of 2 ml/h,a 0.5 ml bolus dose and a 15 min lockout interval.The heart rate(HR),meanarterial pressure(MAP),respiratory rate(RR) and pulse oxygen saturation(SpO2) were recorded before surgery and at 2,6,12,24 and 48 h after surgery.Visual analog scale score(VAS) and Ramsay sedation score were recorded at abovementioned time points.The development of adverse reactions such as nausea and vomiting,pruritus,respiratory depression,hypotension and bradycardia was recorded.Result There was no significant different in HR,MAP,RR and SpO2 at all time points between two groups(P>0.05).The VAS and Ramsay sedation score presented no significantly difference(P>0.05).One and five patients presented nausea and vomiting in P group and S group,respectively.Two cases of pruritus were reported in group S,while no pruritus was reported in group P.Conclusion Both pentazocine 120 mg and sufentanil 0.15 mg have similar analgesia efficacy and fewer adverse reactions in the PCIA in elderly post orthopedic surgery.
引文
[1]涂学云,佘守章,李有武,等.喷他佐辛与吗啡用于老年人术后静脉镇痛效应的比较[J].广东医学,2010,31(10):1228-1230.
[2]李潇潇,翟所迪.喷他佐辛用于麻醉和镇痛的临床研究进展[J].中国临床药理学杂志,2015,31(2):158-160.
[3]杭燕南,王祥瑞,薛张纲,等.当代麻醉学[M].第二版.上海:上海科学技术出版社,2013:123-123.
[4]M鴌niche S,Kehlet H,Dahl JB.A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief:the role of timing of analgesia[J].Anesthesiology,2002,96(3):725-741.
[5]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opiod induced respiratory depression and analgesia with fentanyl and surentanil[J].Anaesth Analg,1990,70:8-15.
[6]Prasad Verma PR,Chandak AR.Development of matrix controlled transdermal delivery systems of pentazocine:in vitro/in vivo performance[J].Acta Pharm,2009,59(2):171-186.
[7]王英伟,王国林,田玉科,等.术后恶心呕吐防治专家共识[EB/OL].(2014)[2018-07-3].http://www.csaol.cn.
[8]Chiba S,Hayashida M,Yoshikawa M,et al.Inhibitory effect of low-dose pentazocine on the development of antinociceptive tolerance to morphine[J].J Anesth,2009,23(1):99-107。
[9]Sandner-Kiesling A,Pan HL,Chen SR,et al.Effect of kappa opioid agonists on visceral nociception induced by uterine cervical distension in rats[J].Pain,2002,96(1-2):13-22.
[10]权哲峰,池萍,张本厚,等.喷他佐辛对剖宫产患者鞘内给予芬太尼引起皮肤瘙痒的影响[J].临床麻醉学杂志,2014,30(3):245-247.
[2]李潇潇,翟所迪.喷他佐辛用于麻醉和镇痛的临床研究进展[J].中国临床药理学杂志,2015,31(2):158-160.
[3]杭燕南,王祥瑞,薛张纲,等.当代麻醉学[M].第二版.上海:上海科学技术出版社,2013:123-123.
[4]M鴌niche S,Kehlet H,Dahl JB.A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief:the role of timing of analgesia[J].Anesthesiology,2002,96(3):725-741.
[5]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opiod induced respiratory depression and analgesia with fentanyl and surentanil[J].Anaesth Analg,1990,70:8-15.
[6]Prasad Verma PR,Chandak AR.Development of matrix controlled transdermal delivery systems of pentazocine:in vitro/in vivo performance[J].Acta Pharm,2009,59(2):171-186.
[7]王英伟,王国林,田玉科,等.术后恶心呕吐防治专家共识[EB/OL].(2014)[2018-07-3].http://www.csaol.cn.
[8]Chiba S,Hayashida M,Yoshikawa M,et al.Inhibitory effect of low-dose pentazocine on the development of antinociceptive tolerance to morphine[J].J Anesth,2009,23(1):99-107。
[9]Sandner-Kiesling A,Pan HL,Chen SR,et al.Effect of kappa opioid agonists on visceral nociception induced by uterine cervical distension in rats[J].Pain,2002,96(1-2):13-22.
[10]权哲峰,池萍,张本厚,等.喷他佐辛对剖宫产患者鞘内给予芬太尼引起皮肤瘙痒的影响[J].临床麻醉学杂志,2014,30(3):245-247.