CAJ | 학술논문

目的：观察不同剂量酮咯酸氨丁三醇和舒芬太尼复合用于老年妇科手术病人术后镇痛的效果强弱及不良反应发生率。方法择期妇科开腹手术病人150例，ASA分级U或Ⅲ级，年龄≥65岁，体重指数18-24kg/m2，采用随机数字表法，将病人随机分为5组(n=30)：单独舒芬太尼组(S组)、酮咯酸氨丁三醇复合舒芬太尼组(按舒芬太尼、酮咯酸氨丁三醇剂量不同，分为M1、M2、M3组)和单独酮咯酸氨丁三醇组（K组）。采用静吸复合全身麻醉下，术后采用静脉病人自控镇痛，S组为舒芬太尼100u g，M1组为舒芬太尼100u g复合酮咯酸氨丁三醇120m g，M2组为舒芬太尼50u g复合酮咯酸氨丁三醇120m g，M3组为舒芬太尼50u g复合酮咯酸氨丁三醇240m g，K组为酮咯酸氨丁三醇240m g，均稀释至100m l，均给予负荷剂量酮咯酸氨丁三醇30m g (手术结束前15m i n时静脉注射)，背景输注速率2.0 ml/h，PCA剂量1.5 ml，锁定时间15min。记录术后3h、6h、12h、24h、48h的VAS评分和PCA按压次数，以及恶心、呕吐、消化道出血等不良反应的发生情况。结果 K组、M2组较其他各组术后各时点V A S评分高、P C A按压次数多（P<0.05）；S组、M1组恶心、呕吐、嗜睡发生率较高（P<0.05）；M3组各时点VAS评分、PCA按压次数高于S组、M1组，但差异无统计学意义（P>0.05），各组患者均未出现消化道出血。结论舒芬太尼50ug复合酮咯酸氨丁三醇240mg用于老年病人术后镇痛，镇痛效果确切，且不良反应发生率低。
목적：관찰불동제량동각산안정삼순화서분태니복합용우노년부과수술병인술후진통적효과강약급불량반응발생솔。방법택기부과개복수술병인150례，ASA분급U혹Ⅲ급，년령≥65세，체중지수18-24kg/m2，채용수궤수자표법，장병인수궤분위5조(n=30)：단독서분태니조(S조)、동각산안정삼순복합서분태니조(안서분태니、동각산안정삼순제량불동，분위M1、M2、M3조)화단독동각산안정삼순조（K조）。채용정흡복합전신마취하，술후채용정맥병인자공진통，S조위서분태니100u g，M1조위서분태니100u g복합동각산안정삼순120m g，M2조위서분태니50u g복합동각산안정삼순120m g，M3조위서분태니50u g복합동각산안정삼순240m g，K조위동각산안정삼순240m g，균희석지100m l，균급여부하제량동각산안정삼순30m g (수술결속전15m i n시정맥주사)，배경수주속솔2.0 ml/h，PCA제량1.5 ml，쇄정시간15min。기록술후3h、6h、12h、24h、48h적VAS평분화PCA안압차수，이급악심、구토、소화도출혈등불량반응적발생정황。결과 K조、M2조교기타각조술후각시점V A S평분고、P C A안압차수다（P<0.05）；S조、M1조악심、구토、기수발생솔교고（P<0.05）；M3조각시점VAS평분、PCA안압차수고우S조、M1조，단차이무통계학의의（P>0.05），각조환자균미출현소화도출혈。결론서분태니50ug복합동각산안정삼순240mg용우노년병인술후진통，진통효과학절，차불량반응발생솔저。
Objective To observe the efficacy of postoperative analgesia and the incidence of side effect of ketorolac tromethamine plus sufentanil with various dose for the elderly gynecological patients. Methods One hundred and fifty ASA I or Il patients.aged≥65 yr,with a body mass index of 18-24 kg/m2,undergoing elective gynecological operation were randomly divided into 5 groups(n=30 each):Solo sufentanil group(group S),ketorolac tromethamine plug sufentanil group(M1,M2,M3 according to the miscellaneous mixture of ketorolac tromethamine)and solo ketorolac tromethamine group(group K).Al groups received combined intravenous-inhalational anesthesia and patient-control ed intravenous analgesia(PCIA)after operation. PCIA solution contained ketorolac tromethamine and or sufentanil : solo 100ug sufentanil (group S), 100ug sufentanil plus ketorolac tromethamine 120mg(group M1), 50ug sufentanil plus ketorolac tromethamine 120mg(group M2), 50ug sufentanil plus ketorolac tromethamine 240mg(group M1),and solo ketorolac tromethamine(group K).Al solution was diluted with normal saline into 100ml.After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of 0peration, <br> The PCA pump was set up with a 1.5ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2.0 ml/h in al groups. The VAS score of 3h,6h,12h,24h,48h after the operation and the incidence of PCA and the side effect of drugs(nausea, vomitting, hemorrhage of digestive tract ) was recorded. Results The VAS score of al time spots in group K and M2 was higher and the incidence of PCA was more than those in other three groups(P<0.05), the incidence of nausea, vomitting and vertigo in group S and M1 was more than those in other groups(P<0.05), The VAS score in group M3 was higher and the incidence of PCA was more than those in group S and M1,but the difference was not statistical y significant(P>0.05). Hemorrhage of digestive tract was not seen in al groups. Conclusion The mixture of ketorolac tromethamine plus sufentanil(diluted into 100ml) could provide proficient analgesia in the elderly patients, with the lower incidence of side effect of drugs.