CAJ | 학술논문

目的评价术中瑞芬太尼不同用量对上腹部手术后患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)效果的影响. 方法选取上腹部手术患者,采用随机数字表法分为两组,每组30例,分别为高剂量瑞芬太尼0.4 μg·kg-1·min-1组(H组)和低剂量瑞芬太尼0.2 μg·kg-1·min-1组(L组),两组均以瑞芬太尼、丙泊酚、阿曲库铵行静脉麻醉,术后采用舒芬太尼行PCIA,分别记录术后2、4、12、24、48 h两组患者疼痛视觉模拟评分(visual anaglogue scale,VAS),镇静评分,术后48 h舒芬太尼消耗量,PCIA总按压次数及副作用的发生情况. 结果术后2、4、12、24 h VAS评分(24±6)、(29±6)、(25±6)、(21±7)与H组(42±7)、(55±6)、(33±6)、(30±6)比较显著下降(P＜0.05),镇静评分L组(2.7±0.3)、(2.3±0.4)、(2.1±0.3)、(2.0±0.1),与H组(1.7±0.2)、(1.5±0.3)、(1.2±0.2)、(1.5±0.3)比较显著升高(P＜0.05),术后48h L组舒芬太尼追加量及PCIA总按压次数分别为(155±9)μg和(5.6±0.9),与H组(176±13) μg和(9.9±0.6)比较分别下降12％和43％(P＜0.05),副作用发生率两组间比较差异无统计学意义(P＞0.05). 结论 L组与H组比较有效改善术后镇痛效果,且无明显副作用.
목적 평개술중서분태니불동용량대상복부수술후환자정맥자공진통(patient-controlled intravenous analgesia,PCIA)효과적영향. 방법 선취상복부수술환자,채용수궤수자표법분위량조,매조30례,분별위고제량서분태니0.4 μg·kg-1·min-1조(H조)화저제량서분태니0.2 μg·kg-1·min-1조(L조),량조균이서분태니、병박분、아곡고안행정맥마취,술후채용서분태니행PCIA,분별기록술후2、4、12、24、48 h량조환자동통시각모의평분(visual anaglogue scale,VAS),진정평분,술후48 h서분태니소모량,PCIA총안압차수급부작용적발생정황. 결과 술후2、4、12、24 h VAS평분(24±6)、(29±6)、(25±6)、(21±7)여H조(42±7)、(55±6)、(33±6)、(30±6)비교현저하강(P＜0.05),진정평분L조(2.7±0.3)、(2.3±0.4)、(2.1±0.3)、(2.0±0.1),여H조(1.7±0.2)、(1.5±0.3)、(1.2±0.2)、(1.5±0.3)비교현저승고(P＜0.05),술후48h L조서분태니추가량급PCIA총안압차수분별위(155±9)μg화(5.6±0.9),여H조(176±13) μg화(9.9±0.6)비교분별하강12％화43％(P＜0.05),부작용발생솔량조간비교차이무통계학의의(P＞0.05). 결론 L조여H조비교유효개선술후진통효과,차무명현부작용.
Objective To assess the effects of intraoperative administration of different doses of remifentanil on postoperative analgesic in patients underwent upper abdominal surgery.Methods Sixty patients underwent upper abdominal surgery were randomly divided into two groups (n=30).They were intraoperatively administrated of high-dose remifentanil 0.4 μg· kg-1· min-1 (group H) or low-dose 0.2 μg·kg-1·min-1 (group L),respectively.Anesthesia was maintained with i.v.propofol,remifentanil and muscle relaxant.Postoperative analgesia was provided by patient-controlled intravenous analgesia (PCIA) with sulfentanyl.The visual analogue scale (VAS) and sedation score were measured at 2,4,12,24,48 h postoperatively.Sulfentanyl consumption was recorded and PCIA effect was observed in postoperative 48 h.Results VAS in group L(24±6,29±6,25±6,21±7) were significantly lower than in the group H(42±7,55±6,33±6,30±6),while the sedation score(2.7±0.3,2.3±0.4,2.5±0.3,2.0±0.1) were higher than in the group H (1.7±0.2,1.5±0.3,1.2±0.2,1.5±0.3) at 2,4,12,24 h postoperatively (P＜0.05).The postoperative total consumption of sulfentanyl (155±9) and the number of PCIA successfully delivered doses (5.6±0.9) in group L were decreased by 12％ and 43％ respectively compared with group H(176±13) μg and(9.9±0.6) (P＜0.05).There was no significant difference on side effects in two groups (P＞0.05).Conclusions Intraoperative administration of low-dose remifentanil can improve postoperative analgesia with no obvious side effects.