昆明医科大学学报
昆明醫科大學學報
곤명의과대학학보
Journal of Kunming Medical University
2014年
2期
67-72
,共6页
杨文燕%邵文萍%王崇谦%乔飞
楊文燕%邵文萍%王崇謙%喬飛
양문연%소문평%왕숭겸%교비
开颅手术%小剂量芬太尼%PCIA%血浆内皮素
開顱手術%小劑量芬太尼%PCIA%血漿內皮素
개로수술%소제량분태니%PCIA%혈장내피소
Craniotomy%Low-doses fentanyl%PCIA%Endothelin
目的：观察开颅手术后用小剂量芬太尼PCIA对患者血浆内皮素的影响．方法择期手术的神经外科患者47例，随机分为2组．实验组26例，术毕静注镇痛负荷量芬太尼50μg后，接上芬太尼PCIA镇痛泵（芬太尼15μg/kg+恩丹斯琼8 mg加入100 mL生理盐水）；对照组术毕静注5 mL生理盐水后，不接镇痛泵．监测2组术前、术毕、术后2 h、4 h、8 h、24 h、48 h时间段的HR、MBP、VSA、血浆内皮素、副作用的变化，并进行比较．结果实验组术后2 h、4 h、8 h、12 h、24 h、48 h心率低于对照组（＜0.05）；实验组术毕及术后2 h平均动脉压低于对照组（＜0.05）；实验组术后8 h、24 h、48 h，血浆内皮素低于对照组（＜0.05）；术后2 h、4 h、8 h、12 h、24 h、48 h两组间VAS评分差异有统计学意义（＜0.05）：实验组术后2 h、4 h、8 h、12 h、24 h VAS0-3分（无痛-轻度疼痛）病例数及百分比明显高于对照组（＜0.05）；副作用方面，意识状况、呼吸抑制、呕吐、镇静评分等副作用2组差异无统计学意义（＞0.05）；实验组发生恶心的次数较多．结论开颅手术后用小剂量芬太尼PCIA镇痛效果良好，副作用小，可减少血浆内皮素的生成，进而缓解脑损伤的程度．
目的：觀察開顱手術後用小劑量芬太尼PCIA對患者血漿內皮素的影響．方法擇期手術的神經外科患者47例，隨機分為2組．實驗組26例，術畢靜註鎮痛負荷量芬太尼50μg後，接上芬太尼PCIA鎮痛泵（芬太尼15μg/kg+恩丹斯瓊8 mg加入100 mL生理鹽水）；對照組術畢靜註5 mL生理鹽水後，不接鎮痛泵．鑑測2組術前、術畢、術後2 h、4 h、8 h、24 h、48 h時間段的HR、MBP、VSA、血漿內皮素、副作用的變化，併進行比較．結果實驗組術後2 h、4 h、8 h、12 h、24 h、48 h心率低于對照組（＜0.05）；實驗組術畢及術後2 h平均動脈壓低于對照組（＜0.05）；實驗組術後8 h、24 h、48 h，血漿內皮素低于對照組（＜0.05）；術後2 h、4 h、8 h、12 h、24 h、48 h兩組間VAS評分差異有統計學意義（＜0.05）：實驗組術後2 h、4 h、8 h、12 h、24 h VAS0-3分（無痛-輕度疼痛）病例數及百分比明顯高于對照組（＜0.05）；副作用方麵，意識狀況、呼吸抑製、嘔吐、鎮靜評分等副作用2組差異無統計學意義（＞0.05）；實驗組髮生噁心的次數較多．結論開顱手術後用小劑量芬太尼PCIA鎮痛效果良好，副作用小，可減少血漿內皮素的生成，進而緩解腦損傷的程度．
목적：관찰개로수술후용소제량분태니PCIA대환자혈장내피소적영향．방법택기수술적신경외과환자47례，수궤분위2조．실험조26례，술필정주진통부하량분태니50μg후，접상분태니PCIA진통빙（분태니15μg/kg+은단사경8 mg가입100 mL생리염수）；대조조술필정주5 mL생리염수후，불접진통빙．감측2조술전、술필、술후2 h、4 h、8 h、24 h、48 h시간단적HR、MBP、VSA、혈장내피소、부작용적변화，병진행비교．결과실험조술후2 h、4 h、8 h、12 h、24 h、48 h심솔저우대조조（＜0.05）；실험조술필급술후2 h평균동맥압저우대조조（＜0.05）；실험조술후8 h、24 h、48 h，혈장내피소저우대조조（＜0.05）；술후2 h、4 h、8 h、12 h、24 h、48 h량조간VAS평분차이유통계학의의（＜0.05）：실험조술후2 h、4 h、8 h、12 h、24 h VAS0-3분（무통-경도동통）병례수급백분비명현고우대조조（＜0.05）；부작용방면，의식상황、호흡억제、구토、진정평분등부작용2조차이무통계학의의（＞0.05）；실험조발생악심적차수교다．결론개로수술후용소제량분태니PCIA진통효과량호，부작용소，가감소혈장내피소적생성，진이완해뇌손상적정도．
Objective To investigate the effect of PCIA with low-dose fentanyl on plasma endothelin (ET) after craniotomy. Methods 47 cases of selected craniotomy were divided randomly into two groups :experimental group (26cases) and control group (21cases) . Patients in experimental group were treated with PCIA (fentanyl 15ug/kg +ondansetron 8 mg+100 mL NS) but patients in control group were not given PCIA. Then HR,MBP, VAS, ET and side-effects were observed and compared between two groups before treatment and 0, 2, 4, 8, 12, 24, 48 h after treatment.Results In experimental group, HR was lower at 2, 4, 8, 12, 24 and 48 h after treatment than control group. MBP was lower at 0 and 2h after treatment in experimental group than control group. Plasma levels of ET were lower at 8, 24 and 48h after treatment in experimental group than control group. There were significant differences in VAS scores at 2,4,8,12,24 and 48 h after treatment between two groups. There was no significant differences in side reactions including consciousness, respiratory depression, vomiting and sedation between two groups. The incidence of nausea was higher in experimental group than control group. Conclusion PCIA with low-dose fentanyl after craniotomy has good analgesic effect and few side reactions, can reduce the formation of plasma endothelin, and then alleviate brain damage.
