CAJ | 학술논문

目的：比较帕瑞昔布钠复合吗啡与氟比洛芬酯复合地佐辛用于结肠癌手术患者自控静脉镇痛（PCIA）的效果，探讨合适的镇痛方案。方法选择ASAⅠ-Ⅱ择期行结肠癌手术的患者90例，随机分为帕瑞昔布钠组（P组）、地佐辛组（D组）和芬太尼组（F组），每组各30例。3组患者均采用气管内插管全身麻醉，术后行PCIA。PCIA设置背景剂量2 ml/h，按压剂量2 ml/次，锁定时间15 min。P组于气管插管前静脉注射帕瑞昔布钠40mg，并于术后12、24、36、48 h静注帕瑞昔布钠40mg，PCIA使用吗啡20 mg+0.9%氯化钠溶液至100ml；D组于气管插管前静脉注射地佐辛5mg，PCIA使用地佐辛30 mg+氟比洛芬酯200mg+0.9%氯化钠溶液至100 ml；F组PCIA使用芬太尼1.0mg+0.9%氯化钠溶液至100 ml。观察3组患者术后30min（T30min）、2h（T2h）、4h（T4h）、12h （T12 h）、24 h（T24 h）、48 h（T48 h）VAS镇痛评分、Ramsay镇静评分及不良反应的情况；术后48h记录PCIA泵按压次数及患者总体满意度。结果 P组及D组在T30min-T12h时点VAS评分显著低于F组（P<0.05）；T30 min-T4h时点，P组Ramsay评分显著低于D组和F组（P<0.05）；术后48h内P组、D组患者头晕发生率显著低于F组（P<0.05）。结论帕瑞昔布钠复合吗啡、地佐辛复合氟比洛芬酯用于结肠癌患者术后的镇痛效果确切，不良反应发生率低。
목적：비교파서석포납복합마배여불비락분지복합지좌신용우결장암수술환자자공정맥진통（PCIA）적효과，탐토합괄적진통방안。방법선택ASAⅠ-Ⅱ택기행결장암수술적환자90례，수궤분위파서석포납조（P조）、지좌신조（D조）화분태니조（F조），매조각30례。3조환자균채용기관내삽관전신마취，술후행PCIA。PCIA설치배경제량2 ml/h，안압제량2 ml/차，쇄정시간15 min。P조우기관삽관전정맥주사파서석포납40mg，병우술후12、24、36、48 h정주파서석포납40mg，PCIA사용마배20 mg+0.9%록화납용액지100ml；D조우기관삽관전정맥주사지좌신5mg，PCIA사용지좌신30 mg+불비락분지200mg+0.9%록화납용액지100 ml；F조PCIA사용분태니1.0mg+0.9%록화납용액지100 ml。관찰3조환자술후30min（T30min）、2h（T2h）、4h（T4h）、12h （T12 h）、24 h（T24 h）、48 h（T48 h）VAS진통평분、Ramsay진정평분급불량반응적정황；술후48h기록PCIA빙안압차수급환자총체만의도。결과 P조급D조재T30min-T12h시점VAS평분현저저우F조（P<0.05）；T30 min-T4h시점，P조Ramsay평분현저저우D조화F조（P<0.05）；술후48h내P조、D조환자두훈발생솔현저저우F조（P<0.05）。결론파서석포납복합마배、지좌신복합불비락분지용우결장암환자술후적진통효과학절，불량반응발생솔저。
Objective To evaluate the efficacy and safety of postoperative patient controlled intravenous analgesia (PCIA) with parecoxib sodium combined with morphin and dezocine combined with flurbiprofen axetil after colon carcinoma surgery.Methods Ninety patients with ASA Ⅰ-Ⅱundergoing elective colon carcinoma surgery were randomly assigned into three groups: parecoxib group (P group), dezocine group (D group) and fentanyl group (F group). They received endotracheal intubation general anesthesia and postoperative PCIA with the background infusion rate 2 ml/h, the bolus infusion rate 2 ml one time and lockout time 15 minutes. The patients in group P were administered parecoxib sodium 40 mg before intubation and 40 mg 12-, 24-, 36-, 48-h after surgery. The PCIA formulation in group P was morphine 20 mg in 100 ml normal saline. The patients in group D were administered dezocine 5 mg before intubation and the PCIA formulation was dezocine 30 mg+ flurbiprofen 200 mg in 100 ml normal saline. The PCIA formulation in group F was fentanyl 1 mg in 100 ml normal saline. VAS score, Ramsay sedation score and the adverse effects were recorded at 30 min (T30min), 2 h (T2h), 4 h (T4h), 12 h (T12h), 24 h (T24h), 48 h (T48h) after surgery. Patient pressing times and patients' satisfactory degree were evaluated 48 hours after surgery. Results At T30 min - T12h time points, the VAS scores in patients of group P and D were lower than those in group F (P<0.05). At T30 min-T4h time points, the Ramsay sedation scores in patients of group P were lower than those in group D and group F (P<0.05). The incidences of dizziness during 48 h after surgery in group P and D were significantly lower than those in group F (P<0.05).Conculsion PCIA with both parecoxib sodium combined with morphin and dezocine combined with flurbiprofen axetil are effective for postoperative pain in patients undergoing colon carcinoma surgery.