CAJ | 학술논문

目的评价酮咯酸氨丁三醇对舒芬太尼用于老年妇科手术病人术后镇痛效果的影响.方法择期妇科开腹手术病人60例,ASA分级Ⅱ或Ⅲ级,年龄≥65岁,体重指数18～24 kg/m2,采用随机数字表法,将病人随机分为2组(n=30):舒芬太尼组(S组)和酮咯酸氨丁三醇混合舒芬太尼组(T组).采用静吸复合全身麻醉下,术后采用静脉病人自控镇痛,T组镇痛药为酮咯酸氨丁三醇和舒芬太尼,负荷剂量酮咯酸氨丁三醇30 mg(手术结束前15 min时静脉注射),酮咯酸氨丁三醇180 mg混合舒芬太尼100μg稀释至100 ml,背景输注速率1.5 ml/h,PCA剂量1.6 ml,锁定时间20 min;S组镇痛药物为舒芬太尼,负荷剂量5μg(手术结束前15 min时静脉注射),舒芬太尼100μg稀释至100 ml,背景输注速率1.5 ml/h,PCA剂量1.6 ml,锁定时间20 min.术后48 h内维持临床有效镇痛(静态和动态VAS评分在3分以下),记录术后48 h舒芬太尼用量和不良反应的发生情况.结果与S组比较,T组术后48 h舒芬太尼用量减少,不良反应发生率降低(P＜0.05).结论酮咯酸氨丁三醇可减少舒芬太尼用于老年妇科手术病人术后镇痛的用量,产生显著的节俭作用,提高镇痛的安全性.
목적 평개동각산안정삼순대서분태니용우노년부과수술병인술후진통효과적영향.방법 택기부과개복수술병인60례,ASA분급Ⅱ혹Ⅲ급,년령≥65세,체중지수18～24 kg/m2,채용수궤수자표법,장병인수궤분위2조(n=30):서분태니조(S조)화동각산안정삼순혼합서분태니조(T조).채용정흡복합전신마취하,술후채용정맥병인자공진통,T조진통약위동각산안정삼순화서분태니,부하제량동각산안정삼순30 mg(수술결속전15 min시정맥주사),동각산안정삼순180 mg혼합서분태니100μg희석지100 ml,배경수주속솔1.5 ml/h,PCA제량1.6 ml,쇄정시간20 min;S조진통약물위서분태니,부하제량5μg(수술결속전15 min시정맥주사),서분태니100μg희석지100 ml,배경수주속솔1.5 ml/h,PCA제량1.6 ml,쇄정시간20 min.술후48 h내유지림상유효진통(정태화동태VAS평분재3분이하),기록술후48 h서분태니용량화불량반응적발생정황.결과 여S조비교,T조술후48 h서분태니용량감소,불량반응발생솔강저(P＜0.05).결론 동각산안정삼순가감소서분태니용우노년부과수술병인술후진통적용량,산생현저적절검작용,제고진통적안전성.
Objective To evaluate the sufentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,with a body mass index of 18-24 kg/m2,undergoing elective gynecological operations,were randomly divided into 2 groups(n =30 each):sufentanil group(group S)and ketorolac tromethamine plus sufentanil group(group T).Both groups received combined intravenous-inhalational anesthesia and patient-controlled intravenous analgesia(PCIA)after operation.PCIA solution contained ketorolac tromethamine 180 mg and sufentanil 100 μg in 100 ml of normal saline in group T.After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 rain lockout interval and background infusion at a rate of 1.5 ml/h in group T.PCIA solution contained sufentanil 100 μg in 100 ml of normal saline in group S.After a loading dose of sufentanil 5 μg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group S.The effective analgesia(postoperative VAS scores at rest and during activity ＜ 3)was maintained within 48 h after operation.The amount of sufentanil consumed within 48 h after operation and adverse effects were recorded.Results Compared with group S,the amount of sufentanil consumed within 48 h after operation was significantly reduced,and the incidence of nausea and vomiting,urinary retention and pruritus was significantly decreased in group T(P ＜ 0.05).Conclusion Ketorolac tromethamine used with PCIA with sufenlanil has a significant sufentanil-sparing effecl for posloperative analgesia and improves the safety of analgesia in the elderly patients.