CAJ | 학술논문

目的：观察舒芬太尼复合氟比洛芬酯静脉输注用于老年骨科患者手术后镇痛的效果、不良反应及对血清白细胞介素6（IL-6）的影响。方法择期行骨科手术老年患者40例，ASAⅡ-Ⅲ级。其中男22例，女18例，年龄65～79岁。将40例患者随机分为A、B组，每组20例。2组患者术后镇痛均使用一次性恒速输注泵。 A组镇痛泵配方为：氟比洛芬酯100 mg ＋舒芬太尼1．5μg/kg＋昂丹司琼0．2 mg/kg＋生理盐水，共120 ml。 B组镇痛泵的配方为：舒芬太尼2μg/kg＋昂丹司琼0．2 mg/kg＋生理盐水，共120 ml。2组患者分别在手术结束前10 min给予芬太尼1μg/kg并随后接镇痛泵。2组患者的麻醉诱导和维持均相同。记录术后2、4、8、12、24 h疼痛视觉模拟评分（ VAS评分）、镇静评分、不良反应和血清IL-6的变化水平。结果2组患者镇痛效果均较满意，各时间点VAS评分组间比较差异无统计学意义（ P＞0．05）。 B组患者恶心、呕吐、过度镇静、呼吸抑制和心动过缓等不良反应的发生率明显高于A组（P＜0．05或P＜0．01），术后4、8和12 h IL-6水平均高于A组（P＜0．05）。结论舒芬太尼复合氟比洛芬酯静脉持续输注用于老年骨科患者术后镇痛效果满意，不良反应较少，可以抑制术后过度炎性反应。
목적：관찰서분태니복합불비락분지정맥수주용우노년골과환자수술후진통적효과、불량반응급대혈청백세포개소6（IL-6）적영향。방법택기행골과수술노년환자40례，ASAⅡ-Ⅲ급。기중남22례，녀18례，년령65～79세。장40례환자수궤분위A、B조，매조20례。2조환자술후진통균사용일차성항속수주빙。 A조진통빙배방위：불비락분지100 mg ＋서분태니1．5μg/kg＋앙단사경0．2 mg/kg＋생리염수，공120 ml。 B조진통빙적배방위：서분태니2μg/kg＋앙단사경0．2 mg/kg＋생리염수，공120 ml。2조환자분별재수술결속전10 min급여분태니1μg/kg병수후접진통빙。2조환자적마취유도화유지균상동。기록술후2、4、8、12、24 h동통시각모의평분（ VAS평분）、진정평분、불량반응화혈청IL-6적변화수평。결과2조환자진통효과균교만의，각시간점VAS평분조간비교차이무통계학의의（ P＞0．05）。 B조환자악심、구토、과도진정、호흡억제화심동과완등불량반응적발생솔명현고우A조（P＜0．05혹P＜0．01），술후4、8화12 h IL-6수평균고우A조（P＜0．05）。결론서분태니복합불비락분지정맥지속수주용우노년골과환자술후진통효과만의，불량반응교소，가이억제술후과도염성반응。
Objective To investigate the post-operative analgesic effect , adverse effect and the level of IL -6 in orthopedic elderly patients after combined use of sufentanil and flurbiprofen .Methods Forty ASA II-III patients (22 men and 18 women) aged 65-79 years were randomly divided into two groups (Groups A and B, 20 for each), who un-derwent orthopaedic surgery and infused with various agents for post -operative analgesia via a disposable pump .Group A was infused with 100 mg flurbiprofen, 1.5 μg/kg sufentanyl and 0.2 mg/kg ondansetron in 120 ml of normal saline. Group B was received 2.0 μg/kg sufentanyl and 0.2 mg/kg ondansetron in 120 ml of normal saline.Patients in both groups were given 1.0μg/kg fentanyl 10 min before the end of surgery followed by pump infusion .Their analgesic induc-tion and maintenance conditions were identical .Then, the scores of VAS and sedation , side effects and the level of serum IL-6 were recorded 2, 4, 8, 12 and 24 hours after operation.Results The analgesic effects were favorable in the two groups.There was no significant difference between both groups as to VAS score (P>0.05).Compared with group A, patients in group B complained significantly higher rates of side effects like nausea , vomiting, hypersedation, respiratory depression, and bradycardia (P<0.05 or P<0.01).Meanwhile, the amount of serum IL -6 in group A was remark-ably decreased than those in group B 4, 8 and 12 hours after surgery (P<0.05).Conclusions Intravenous infusion of sufentanil and flurbiprofen can offer favorable analgesic effects , with less side effects and post -operative inflammatory re-sponses .