超前镇痛对鼻腔手术后头痛的干预效应  

Interventional effect of preemptive analgesia on headache after operation on nasal cavity

作　　者：徐志强[1] 王小兰[2] 王少敏[3] 

机构地区：[1]连云港市第一人民医院麻醉科,江苏省连云港市222002 [2]连云港市第一人民医院耳鼻喉科,江苏省连云港市222002 [3]连云港市第一人民医院手术室,江苏省连云港市222002

出　　处：《中国临床康复》2005年第45期14-15,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察超前镇痛用于鼻腔手术后头痛的镇痛效果,探讨其临床应用的可行性。方法:将2003-06/2004-12连云港市第一人民医院收治的需行鼻腔手术患者116例,随机分为3组:对照组35例术后口服尼美舒利片100mg,2次/d;超前镇痛组43例在手术开始前0.5～1.0h静脉注射芬太尼1μg/kg为负荷量,随后使用患者自控静脉镇痛输液泵,药物为芬太尼1.0mg、氟哌利多5mg加生理盐水至100mL,背景量1.0mL/h,单次追加量0.5mL,锁定时间为15min,维持48h;术后镇痛组38例在手术结束时使用自控静脉镇痛输液泵,用药与参数同超前镇痛组。观察各组术后镇痛效果、用药量及不良反应。疼痛采用目测类比评分法评估,0分代表无痛,10分代表极痛;综合术后2d结果评价镇痛效果:0～2分为优,3～4分为良,5～6为一般,7分以上为差,计算3组的优良率。结果:116例患者均进入结果分析。镇痛优良率:超前镇痛组和术后镇痛组显著高于对照组[86%(37/43),74%(28/38),26%(9/35),χ2=16.773～29.028,P<0.01],超前镇痛组和术后镇痛组两组比较无显著差异(χ2=1.945,P>0.05)。用药量:超前镇痛组明显少于术后镇痛组[(67.9±6.9),(84.3±5.7)mL,t=11.549,P<0.01]。不良反应:超前镇痛组与术后镇痛组无显著性差异(χ2=0.152～0.711,P>0.05)。结论:在鼻腔手术应用超前镇痛与术后再应用自控静脉镇痛的镇痛效果均良好,因超前镇痛的用药总量明显减少,故使用较为安全,值得临床应用。AIM： To observe the analgesic effect of preemptive analgesia on headache following operation on nasal cavity, and investigate the feasibility of its clinical application. METHODS： One hundred and sixteen patients who needed an operation on nasal cavity admitted to the First People＇s Hospital of Lianyungong from June 2003 to December 2004 were enrolled and randomized into three groups： 35 cases in control group received oral administration of Nimesulide 100 mg, twice a day after operation; 43 in preemptive analgesia group were injected with 1μg/kg fentanvl intravenously at 0.5-1 hour before operation, and then self-controlled venous infusion pttmp was used for venous injection of 100 mL normal saline containing fentanvl 1.0 mg and droperidol 5 mg（background volume： 1.0 mL per hour, adding volume for one time： 0.5 mL, locked time： 15 minutes, duration： 48 hours）; 38 in post-operative analgesia group were undertaken self-controlled venous infusion pump same as the preemptive analgesia group. Post-operative analgesic effect, medication and adverse effect were observed in all the groups. Degree of pain was assessed with visual analogue scale（VAS）, score 0 as no pain and 10 as very pain; in contrast to the analgesic effect of 2-day post-operation, scores 0-2 were considered as good, 3-4 as fair, 5-6 as general, 7 or above as bad, and then the effective rate was calculated in the 3 groups. RESULTS： All the 116 patients were involved in the result analysis. Effective rate of analgesia： It was higher in the preemptive analgesia group and post-operative analgesia group as compared with the control group[86% （37/43）,74%（28/38） ,26%（9/35）,X^2=16.773-29.028 ,P 〈 0.01]. And there was no difference between the preemptive analgesia group and postoperative analgesia group （X^2=1.945 ,P 〉 0.05）. Medication： It was lower significantly in the preemptive analgesia group as compared with the postoperative analgesia group[ （67.9±6.9）, （84.3±5.7） mL,t=11.549,P〈0.01 ]. Ad

关 键 词：头痛 鼻 镇痛 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]