舒芬太尼复合地佐辛用于痔上黏膜环切术后自控镇痛的剂量研究
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摘要
目的通过比较不同剂量舒芬太尼复合固定剂量地佐辛在吻合器痔上黏膜环切术(PPH)术后患者静脉自控镇痛(PCIA)的临床疗效及安全性,探讨舒芬太尼复合地佐辛用于PPH术后PCIA的最佳药物比例。方法择期行PPH的患者(ASAⅠ级或Ⅱ级)90例,采用随机数字表法均分为A组、B组与C组,每组30例。3组患者术后PCIA镇痛泵配方分别为:A组:舒芬太尼1.0μg/kg+地佐辛0.3 mg/kg+格拉司琼6 mg+生理盐水至100 ml;B组:舒芬太尼1.5μg/kg+地佐辛0.3 mg/kg+格拉司琼6 mg+生理盐水至100 ml;C组:舒芬太尼2.0μg/kg+地佐辛0.3 mg/kg+格拉司琼6 mg+生理盐水至100 ml。记录并比较3组患者术后6 h(T_1)、12 h(T_2)、24 h(T_3)以及48 h(T_4)的Ramsay镇静评分(RSS)及疼痛视觉模拟评分(VAS)、术后24 h内PCIA总按压次数与用药总量以及术后不良反应的发生情况。结果 T_1时,B组、C组患者RSS评分高于A组,差异有统计学意义(P<0.05);T_1时静息状态下A组患者VAS评分高于B组、C组,差异有统计学意义(P<0.05);其他时间点静息状态下3组患者VAS比较,差异无统计学意义;术后不同时间点翻身运动时3组患者VAS评分的差异无统计学意义;A组术后24 h内PCIA总按压次数与用药总量均高于B组、C组,其中用药总量的组间比较,差异有统计学意义(P<0.05);C组患者不良反应总的发生率高于A组、B组,差异有统计学意义(P<0.05)。结论不同剂量舒芬太尼复合固定剂量地佐辛用于PPH术后PCIA,当药物比例为1.5μg/kg舒芬太尼复合0.3 mg/kg地佐辛时镇静、镇痛效果较好,且不良反应的发生率较低,安全性较高。
Objective To investigate the optimal proportion of sufentanil and dizocine for PCIA after PCI. Methods 90 patients undergoing elective PPH were randomly divided into Group A, Group B and Group C with 30 patients in each group. Group A: Sufentanil 1.0 μg/kg + Dezocine 0.3 mg/kg + Granisetron 6 mg + normal saline to 100 ml; Group B: Sufentanil 1.5 μg/kg + Dezocine 0.3 mg/kg + Granisetron 6 mg + Physiological Saline to 100 ml; Group C: Sufentanil 2.0 μg/kg + Dizocine 0.3 mg/kg + Granisetron 6 mg + normal saline to 100 ml. The RSS scores and VAS scores at 6 h(T_1), 12 h(T_2), 24 h(T_3), and 48 h(T_4) after surgery in the three groups of patients, and the total number of PCIA compressions within 24 h after surgery, total medication and occurrence of adverse reactions after surgery were recorded and compared. Results At T_1, the RSS scores of patients in group B and C were higher than those in group A(P<0.05). At the time of T_1, the VAS score in group A was higher than that in group B and C(P<0.05). The total number of PCIA compressions and the total amount of PCIA in group A were higher than those in group B and group C within24 hours after operation(P<0.05). The overall incidence of adverse reactions in group C was higher than that in group A and B(P<0.05).Conclusion Different doses of sufentanil combined fixed dose of dizocine for PCIA after PCI, when the ratio of the drug is 1.5 μg/kg sufentanil0.3 mg/kg dizocine, the sedative and analgesic effects are better, and the adverse effects are good The incidence of reactions is low and safety is high.
Objective To investigate the optimal proportion of sufentanil and dizocine for PCIA after PCI. Methods 90 patients undergoing elective PPH were randomly divided into Group A, Group B and Group C with 30 patients in each group. Group A: Sufentanil 1.0 μg/kg + Dezocine 0.3 mg/kg + Granisetron 6 mg + normal saline to 100 ml; Group B: Sufentanil 1.5 μg/kg + Dezocine 0.3 mg/kg + Granisetron 6 mg + Physiological Saline to 100 ml; Group C: Sufentanil 2.0 μg/kg + Dizocine 0.3 mg/kg + Granisetron 6 mg + normal saline to 100 ml. The RSS scores and VAS scores at 6 h(T_1), 12 h(T_2), 24 h(T_3), and 48 h(T_4) after surgery in the three groups of patients, and the total number of PCIA compressions within 24 h after surgery, total medication and occurrence of adverse reactions after surgery were recorded and compared. Results At T_1, the RSS scores of patients in group B and C were higher than those in group A(P<0.05). At the time of T_1, the VAS score in group A was higher than that in group B and C(P<0.05). The total number of PCIA compressions and the total amount of PCIA in group A were higher than those in group B and group C within24 hours after operation(P<0.05). The overall incidence of adverse reactions in group C was higher than that in group A and B(P<0.05).Conclusion Different doses of sufentanil combined fixed dose of dizocine for PCIA after PCI, when the ratio of the drug is 1.5 μg/kg sufentanil0.3 mg/kg dizocine, the sedative and analgesic effects are better, and the adverse effects are good The incidence of reactions is low and safety is high.
引文
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[3]高玮,赵琳,段满林,等.地佐辛联合舒芬太尼在上腹部及髋关节置换术后镇痛的临床研究[J].临床麻醉学杂志,2014,30(6):532-535.
[4]李仁淑,张广建,金明,等.丙泊酚联合地佐辛在无痛人流术中的疗效及安全性研究[J].中国妇幼保健,2013,28(23):3878-3880.
[5]阳婷婷,唐轶洋,张兴安,等.舒芬太尼与瑞芬太尼复合丙泊酚全凭静脉麻醉用于神经外科手术效果与安全性的系统评价[J].中国循证医学杂志,2013,13(12):1492-1499.
[6]赵小利,李洁琼,李昊,等.Ramsay评分对降低非计划性拔管发生率及镇静药物使用的影响[J].中国医药,2016,11(5):698-700.
[7]王向阳,赵晶,张伟,等.右美托咪定联合舒芬太尼用于术后镇痛对宫颈癌根治术患者心血管稳定性及VAS评分的影响[J].中国妇幼健康研究,2017,28(5):606-608.
[8]雍桂珍,兰长骏,甘宇业,等.LASIK手术疼痛的干预护理对手术疗效的影响[J].护士进修杂志,2014,29(21):1926-1928.
[9]徐怡琼,罗艳,于布为,等.骨科手术患者全身麻醉苏醒期高血压的发生情况[J].上海医学,2013,36(2):102-105.
[10]叶明春.普通外科手术护理管理与手术感染和疼痛的相关性分析[J].河北医药,2015,41(8):1276-1278.
[11]鲁义,屠伟峰,卿朝晖,等.静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度及并发症影响的比较[J].临床麻醉学杂志,2015,31(2):109-112.
[12]杨扬,李婕,王守慧,等.阿片类未耐受患者芬太尼静脉自控镇痛滴定芬太尼透皮贴剂的安全性与有效性[J].中国肿瘤临床,2016,43(5):194-198.
[13]杨宏富,孙荣青,常银江,等.舒芬太尼对重症监护病房危重患者镇痛/镇静治疗的多中心随机对照临床研究[J].中华危重病急救医学,2014,26(2):94-100.
[14]李金凤,高昭,王建民,等.不同剂量舒芬太尼对大鼠麻醉及恢复的影响[J].南京理工大学学报(医学版),2013,37(3):453-456.
[15]徐建国,罗爱伦,吴新民,等.地佐辛术后镇痛专家建议[J].临床麻醉学杂志,2013,29(9):921-922.