CAJ | 학술논문

目的：观察丙帕他莫复合舒芬太尼在老年患者全髋置换术后多模式镇痛中的效果及安全性。方法60例接受全髋置换术的老年患者，随机分成2组，分别为丙帕他莫复合舒芬太尼组（A组）与舒芬太尼组（B组），每组30例。 A组术后静脉自控镇痛（ PCIA）配方：丙帕他莫8 g＋舒芬太尼1μg/kg＋10 mg托烷司琼＋生理盐水，总量100 mL；B组PCIA配方：舒芬太尼2μg/kg＋10 mg托烷司琼＋生理盐水，总量100 mL。两组镇痛液负荷量5 mL， PCIA镇痛泵维持量1．8 mL/h，追加量0．5 mL，锁定时间15 min。观察术后4、8、12、24、48 h静息及活动时疼痛VAS评分、镇静Ramsay评分，记录镇痛泵药物消耗容量及自控按压次数，并记录不良反应。结果两组老年患者术后各时点静息及活动时镇痛评分比较差异无显著性意义，P＞0．05；B组术后4、8、12 h Ramsay评分与A组比较差异有显著性意义，B组分别为3．17±0．95、3．23±0．90、3．13±0．82，A组分别为2．43±0．77、2．40±0．77、2．33±0．71，P＜0．01；两组镇痛泵药物消耗容量及自控按压次数比较差异无显著性意义，P＞0．05；镇痛期间不良反应发生率比较差异有显著性意义，恶心、头晕发生率B组分别为26．67％、23．33％，高于A组的6．67％、3．33％， P＜0．05。结论丙帕他莫复合舒芬太尼用于老年患者全髋置换术后多模式镇痛安全有效，不良反应发生率低。
목적：관찰병파타막복합서분태니재노년환자전관치환술후다모식진통중적효과급안전성。방법60례접수전관치환술적노년환자，수궤분성2조，분별위병파타막복합서분태니조（A조）여서분태니조（B조），매조30례。 A조술후정맥자공진통（ PCIA）배방：병파타막8 g＋서분태니1μg/kg＋10 mg탁완사경＋생리염수，총량100 mL；B조PCIA배방：서분태니2μg/kg＋10 mg탁완사경＋생리염수，총량100 mL。량조진통액부하량5 mL， PCIA진통빙유지량1．8 mL/h，추가량0．5 mL，쇄정시간15 min。관찰술후4、8、12、24、48 h정식급활동시동통VAS평분、진정Ramsay평분，기록진통빙약물소모용량급자공안압차수，병기록불량반응。결과량조노년환자술후각시점정식급활동시진통평분비교차이무현저성의의，P＞0．05；B조술후4、8、12 h Ramsay평분여A조비교차이유현저성의의，B조분별위3．17±0．95、3．23±0．90、3．13±0．82，A조분별위2．43±0．77、2．40±0．77、2．33±0．71，P＜0．01；량조진통빙약물소모용량급자공안압차수비교차이무현저성의의，P＞0．05；진통기간불량반응발생솔비교차이유현저성의의，악심、두훈발생솔B조분별위26．67％、23．33％，고우A조적6．67％、3．33％， P＜0．05。결론병파타막복합서분태니용우노년환자전관치환술후다모식진통안전유효，불량반응발생솔저。
Objective To observe the analgesic efficacy and safety of propacetamol combined with sufentanyl for multimod -el analgesia in aged patients after total hip replacement operation .Methods Sixty aged patients undergoing total hip replace-ment operation were randomly divided into two groups , with 30 patients in each group:the propacetamol plus sufentanil group(group A) and the sufentanil group (group B).The composition of patient -controlled intravenous analgesia (PCIA) was as follows:the group A,8g propacetamol,1 μg/kg sufentanil and 10 mg tropisetron in 100 mL saline;the group B,2μg/kg sufentanil and 10 mg tropisetron in 100 mL saline;both groups had the loading dose 5 mL,the infusion rate 1.8 mL/h,bolus dose 0.5 mL,and lockout time 15 min.Visual analog score(VAS) of pain when silence and when moving ,Ramsay sedation score were measured at 4,8,12,24 and 48 h during the analgesia .The volume of analgesics used ,application of bo-lus and side effects were recorded .Results There was no significant difference with the scores of VAS either when silence or when moving at each time points between the two groups ,P>0.05.The Ramsay scores in the group B at 4,8 and 12 h were 3.17 ±0.95, 3.23 ±0.90, 3.13 ±0.82, while those in the group A were 2.43 ±0.77, 2.40 ±0.77, 2.33 ±0.71, there were significant differences ,P<0.01.There was no significant difference with the volume of analgesics used and application of bolus between the two groups , P>0.05.The incidence of nausea and dizziness in the group B were 26.67%,23.33%, while those in the group A were 6.67%,3.33%,there were significant differences ,P<0.05.Conclusion Propacetamol combined with sufentanil produces effective analgesia in aged patients after total hip replacement operation with less side effects.