目的 观察不同剂量舒芬太尼复合氟比洛芬酯用于胃癌术后患者的镇痛效果.方法 选择择期行胃癌切除术患者90例,完全随机分为Ⅰ、Ⅱ、Ⅲ组,每组30例,术后均行静脉自控镇痛(PCIA).3组镇痛均使用氟比洛芬酯2 mg/kg与托烷司琼5 mg,以0.9％氯化钠注射液稀释至100 ml,Ⅰ组另加用舒芬太尼1.5 μg/kg,Ⅱ组为舒芬太尼2.0 μg/kg,Ⅲ组为舒芬太尼2.5 μg/kg.观察并记录术后2、4、8、12、24、48 h患者视觉模拟评分(VAS评分)和Ramsay评分,分别评价镇痛效果和镇静效果;记录0～2h、＞2 ～4 h、＞4～8 h、＞8～12h、＞12 ～24 h和＞24 ～ 48 h PCIA有效按压次数和不良反应发生情况.结果 ①Ⅱ组和Ⅲ组术后4、8、12 h VAS评分低于Ⅰ组,组间差异有统计学意义[术后4、8、12 h VAS评分:Ⅰ组分别为(3.53 ±0.62)、(3.01±0.32)、(2.60 ±0.85)分,Ⅱ组分别为(2.71±0.53)、(1.95±0.43)、(1.36±0.42)分,Ⅲ组分别为(2.65±0.42)、(1.82±0.35)、(1.29±0.36)分,P＜0.05];Ⅱ组和Ⅲ组术后2、24和48 h与Ⅰ组的差异无统计学意义(P＞0.05);术后各时点Ⅱ组和Ⅲ组VAS评分的差异无统计学意义(P＞0.05).②Ⅱ组和Ⅲ组术后4、8、12 h Ramsay评分高于Ⅰ组,组间差异有统计学意义[术后4、8、12 h Ramsay评分:Ⅰ组分别为(2.51±0.42)、(2.59±0.79)、(2.66±0.53)分,Ⅱ组分别为(3.32±0.52)、(3.48±0.72)、(3.51±0.43)分,Ⅲ组分别为(3.31±0.31)、(3.50±1.00)、(3.42±0.50)分,P＜0.05];Ⅱ组和Ⅲ组术后2、24和48 h与Ⅰ组的差异无统计学意义(P＞0.05);术后各时点Ⅱ组和Ⅲ组的Ramsay评分差异无统计学意义(P＞0.05).③术后0～2 h、＞2～4h、＞4～8h、＞8～12 h、＞12 ～24 h,Ⅱ组和Ⅲ组PCIA按压次数均明显少于Ⅰ组,差异均有统计学意义[术后0～2h、＞2 ～4 h、＞4～8 h、＞8～12 h、＞12～24 hPCIA按压次数:Ⅰ组分别为(2.81±0.61)、(3.32±0.91)、(4.65±0.38)、(5.37±0.78)、(4.87±0.92)次,Ⅱ组分别为(1.40±0.50)、(1.72±0.54)、(2.97±0.63)、(3.61±0.83)、(3.02±0.65)次,Ⅲ组分别为(1.37±0.65)、(1.69±0.38)、(2.89±0.42)、(3.42±0.25)、(2.95±0.43)次,P＜0.05];Ⅱ组和Ⅲ组PCIA按压次数比较,差异无统计学意义(P＞0.05).术后＞24～48 h,3组间PCIA按压次数差异无统计学意义(P＞0.05).④Ⅰ、Ⅱ和Ⅲ组恶心、呕吐发生率分别为6.7％(2例)、6.7％(2例)和40.0％(12例),Ⅲ组恶心、呕吐发生率高于Ⅰ组和Ⅱ组,差异有统计学意义(P＜0.05);仅Ⅲ组有1例患者(3.3％)发生皮肤瘙痒;3组均未发生呼吸抑制和尿潴留.结论 不同剂量舒芬太尼用于胃癌术后静脉自控镇痛均可满足镇痛需求,其中舒芬太尼2.0 μg/kg镇痛效果更确切,镇静效果适中,不良反应少.
目的 觀察不同劑量舒芬太尼複閤氟比洛芬酯用于胃癌術後患者的鎮痛效果.方法 選擇擇期行胃癌切除術患者90例,完全隨機分為Ⅰ、Ⅱ、Ⅲ組,每組30例,術後均行靜脈自控鎮痛(PCIA).3組鎮痛均使用氟比洛芬酯2 mg/kg與託烷司瓊5 mg,以0.9％氯化鈉註射液稀釋至100 ml,Ⅰ組另加用舒芬太尼1.5 μg/kg,Ⅱ組為舒芬太尼2.0 μg/kg,Ⅲ組為舒芬太尼2.5 μg/kg.觀察併記錄術後2、4、8、12、24、48 h患者視覺模擬評分(VAS評分)和Ramsay評分,分彆評價鎮痛效果和鎮靜效果;記錄0～2h、＞2 ～4 h、＞4～8 h、＞8～12h、＞12 ～24 h和＞24 ～ 48 h PCIA有效按壓次數和不良反應髮生情況.結果 ①Ⅱ組和Ⅲ組術後4、8、12 h VAS評分低于Ⅰ組,組間差異有統計學意義[術後4、8、12 h VAS評分:Ⅰ組分彆為(3.53 ±0.62)、(3.01±0.32)、(2.60 ±0.85)分,Ⅱ組分彆為(2.71±0.53)、(1.95±0.43)、(1.36±0.42)分,Ⅲ組分彆為(2.65±0.42)、(1.82±0.35)、(1.29±0.36)分,P＜0.05];Ⅱ組和Ⅲ組術後2、24和48 h與Ⅰ組的差異無統計學意義(P＞0.05);術後各時點Ⅱ組和Ⅲ組VAS評分的差異無統計學意義(P＞0.05).②Ⅱ組和Ⅲ組術後4、8、12 h Ramsay評分高于Ⅰ組,組間差異有統計學意義[術後4、8、12 h Ramsay評分:Ⅰ組分彆為(2.51±0.42)、(2.59±0.79)、(2.66±0.53)分,Ⅱ組分彆為(3.32±0.52)、(3.48±0.72)、(3.51±0.43)分,Ⅲ組分彆為(3.31±0.31)、(3.50±1.00)、(3.42±0.50)分,P＜0.05];Ⅱ組和Ⅲ組術後2、24和48 h與Ⅰ組的差異無統計學意義(P＞0.05);術後各時點Ⅱ組和Ⅲ組的Ramsay評分差異無統計學意義(P＞0.05).③術後0～2 h、＞2～4h、＞4～8h、＞8～12 h、＞12 ～24 h,Ⅱ組和Ⅲ組PCIA按壓次數均明顯少于Ⅰ組,差異均有統計學意義[術後0～2h、＞2 ～4 h、＞4～8 h、＞8～12 h、＞12～24 hPCIA按壓次數:Ⅰ組分彆為(2.81±0.61)、(3.32±0.91)、(4.65±0.38)、(5.37±0.78)、(4.87±0.92)次,Ⅱ組分彆為(1.40±0.50)、(1.72±0.54)、(2.97±0.63)、(3.61±0.83)、(3.02±0.65)次,Ⅲ組分彆為(1.37±0.65)、(1.69±0.38)、(2.89±0.42)、(3.42±0.25)、(2.95±0.43)次,P＜0.05];Ⅱ組和Ⅲ組PCIA按壓次數比較,差異無統計學意義(P＞0.05).術後＞24～48 h,3組間PCIA按壓次數差異無統計學意義(P＞0.05).④Ⅰ、Ⅱ和Ⅲ組噁心、嘔吐髮生率分彆為6.7％(2例)、6.7％(2例)和40.0％(12例),Ⅲ組噁心、嘔吐髮生率高于Ⅰ組和Ⅱ組,差異有統計學意義(P＜0.05);僅Ⅲ組有1例患者(3.3％)髮生皮膚瘙癢;3組均未髮生呼吸抑製和尿潴留.結論 不同劑量舒芬太尼用于胃癌術後靜脈自控鎮痛均可滿足鎮痛需求,其中舒芬太尼2.0 μg/kg鎮痛效果更確切,鎮靜效果適中,不良反應少.
목적 관찰불동제량서분태니복합불비락분지용우위암술후환자적진통효과.방법 선택택기행위암절제술환자90례,완전수궤분위Ⅰ、Ⅱ、Ⅲ조,매조30례,술후균행정맥자공진통(PCIA).3조진통균사용불비락분지2 mg/kg여탁완사경5 mg,이0.9％록화납주사액희석지100 ml,Ⅰ조령가용서분태니1.5 μg/kg,Ⅱ조위서분태니2.0 μg/kg,Ⅲ조위서분태니2.5 μg/kg.관찰병기록술후2、4、8、12、24、48 h환자시각모의평분(VAS평분)화Ramsay평분,분별평개진통효과화진정효과;기록0～2h、＞2 ～4 h、＞4～8 h、＞8～12h、＞12 ～24 h화＞24 ～ 48 h PCIA유효안압차수화불량반응발생정황.결과 ①Ⅱ조화Ⅲ조술후4、8、12 h VAS평분저우Ⅰ조,조간차이유통계학의의[술후4、8、12 h VAS평분:Ⅰ조분별위(3.53 ±0.62)、(3.01±0.32)、(2.60 ±0.85)분,Ⅱ조분별위(2.71±0.53)、(1.95±0.43)、(1.36±0.42)분,Ⅲ조분별위(2.65±0.42)、(1.82±0.35)、(1.29±0.36)분,P＜0.05];Ⅱ조화Ⅲ조술후2、24화48 h여Ⅰ조적차이무통계학의의(P＞0.05);술후각시점Ⅱ조화Ⅲ조VAS평분적차이무통계학의의(P＞0.05).②Ⅱ조화Ⅲ조술후4、8、12 h Ramsay평분고우Ⅰ조,조간차이유통계학의의[술후4、8、12 h Ramsay평분:Ⅰ조분별위(2.51±0.42)、(2.59±0.79)、(2.66±0.53)분,Ⅱ조분별위(3.32±0.52)、(3.48±0.72)、(3.51±0.43)분,Ⅲ조분별위(3.31±0.31)、(3.50±1.00)、(3.42±0.50)분,P＜0.05];Ⅱ조화Ⅲ조술후2、24화48 h여Ⅰ조적차이무통계학의의(P＞0.05);술후각시점Ⅱ조화Ⅲ조적Ramsay평분차이무통계학의의(P＞0.05).③술후0～2 h、＞2～4h、＞4～8h、＞8～12 h、＞12 ～24 h,Ⅱ조화Ⅲ조PCIA안압차수균명현소우Ⅰ조,차이균유통계학의의[술후0～2h、＞2 ～4 h、＞4～8 h、＞8～12 h、＞12～24 hPCIA안압차수:Ⅰ조분별위(2.81±0.61)、(3.32±0.91)、(4.65±0.38)、(5.37±0.78)、(4.87±0.92)차,Ⅱ조분별위(1.40±0.50)、(1.72±0.54)、(2.97±0.63)、(3.61±0.83)、(3.02±0.65)차,Ⅲ조분별위(1.37±0.65)、(1.69±0.38)、(2.89±0.42)、(3.42±0.25)、(2.95±0.43)차,P＜0.05];Ⅱ조화Ⅲ조PCIA안압차수비교,차이무통계학의의(P＞0.05).술후＞24～48 h,3조간PCIA안압차수차이무통계학의의(P＞0.05).④Ⅰ、Ⅱ화Ⅲ조악심、구토발생솔분별위6.7％(2례)、6.7％(2례)화40.0％(12례),Ⅲ조악심、구토발생솔고우Ⅰ조화Ⅱ조,차이유통계학의의(P＜0.05);부Ⅲ조유1례환자(3.3％)발생피부소양;3조균미발생호흡억제화뇨저류.결론 불동제량서분태니용우위암술후정맥자공진통균가만족진통수구,기중서분태니2.0 μg/kg진통효과경학절,진정효과괄중,불량반응소.
Objective To investigate the feasibility and suitable doses of sufentanil combined with flurbiprofen in postoperative patient-controlled intravenous analgesia(PCIA) in patients receiving stomach cancer surgery.Methods Ninety patients receiving stomach cancer surgery were randomly divided into three groups with different prescriptions.Group Ⅰ had sufentanil 1.5 μg/kg; group Ⅱ had sufentanil 2.0 μg/kg; group Ⅲ had sufentanil 2.5 μg/kg.Flurbiprofen 2 mg/kg and tropisetron 5 mg were added in every group.The visual analgesia scale (VAS),sedative scores,pressing times of PCIA and the side effects were observed.Results ①4,8,12 h VAS scores in group Ⅱ and group Ⅲ postoperative were lower than those in group Ⅰ with a significant difference between the groups[after 4,8,12 h VAS score:group Ⅰ were (3.53 ±0.62) scores,(3.01 ±0.32) scores,(2.60 ±0.85) scores,group Ⅱ were (2.71 ±0.53) scores,(1.95 ±0.43) scores,(1.36 ±0.42) scores,group Ⅲ were (2.65 ± 0.42) scores,(1.82 ± 0.35) scores,(1.29 ± 0.36) scores,all P ＜ 0.05] ; the VAS scores after 2,24and 48h had no significant differences between the three groups (P ＞ 0.05) ; there were no significant difference at each time point of postoperation in group Ⅱ and group Ⅲ (P ＞0.05).②4,8,12 h Ramsay scores in group Ⅱ and group Ⅲ postoperative were higher than those in group Ⅰ with a significant difference between the groups[after 4,8,12 h Ramsay score:group Ⅰ were (2.51 ± 0.42) scores,(2.59 ± 0.79) scores,(2.66 ±0.53)scores,group Ⅱ were (3.32±0.52) scores,(3.48±0.72) scores,(3.51 ±0.43) scores,group Ⅲ were (3.31 ± 0.31) scores,(3.50 ± 1.00) scores,(3.42 ± 0.50),all P ＜ 0.05] ; there were no statistical significance in the three groups after 2,24 and 48 h (P ＞ 0.05) and no significant difference at each time point of postoperation in group Ⅱ and group Ⅲ(P＞0.05).③After 0-2 h,＞ 2-4 h,＞ 4-8 h,＞ 8-12,12-24 h,PCIA pressing times in group Ⅱ and group Ⅲ were significantly less than those in group Ⅰ ; the differences were statistically significant[Ⅰ group were (2.81 ± 0.61) times,(3.32 ± 0.91) times,(4.65 ± 0.38) times,(5.37 ±0.78) times,(4.87 ±0.92)times,group Ⅱ were (1.40±0.50) times,(1.72 ±0.54) times,(2.97 ±0.63) times,(3.61±0.83) times,(3.02 ±0.65) times,group Ⅲ were (1.37 ±0.65) times,(1.69±0.38) times,(2.89 ± 0.42) times,(3.42 ± 0.25) times,(2.95 ± 0.43) times,all P ＜ 0.05] ; the difference of PCIA pressing times in group Ⅱ and group Ⅲ was not statistically significant(P ＞ 0.05) ; after ＞ 24-48 h,the difference of PCIA pressing times between the three groups were not statistically significant(P ＞0.05).The incidence of nausea and vomiting in group Ⅰ,group Ⅱ and group Ⅲ was 6.7％ (2 cases),6.7％ (2 cases) and 40.0％ (12 cases) ; the incidence of nausea and vomiting in group Ⅲ were higher than that in group Ⅰ and group Ⅱ (P ＜0.05) ; only one patient (3.3％) had skin pruritus in group Ⅲ ; the 3 groups had no inhibition of respiratory and urinary retention.Conclusion The analgesic effect and sedative effect of PCIA with combination of sufentanil 2.0 μg/kg and flurbiprofen axetil 2 mg/kg are good.
