芬太尼和吗啡在全麻开胸术后病人静脉自控镇痛作用效果的对比研究  

Effects of fentanil and morphine in patients controlled analgesia after thoracotomy

作　　者：王娟[1] 刘明华[1] 文亮[1] 尹昌林[1] 

机构地区：[1]重庆市第三军医大学西南医院急救部,重庆400038

出　　处：《现代生物医学进展》2009年第19期3682-3684,共3页Progress in Modern Biomedicine

摘　　要：目的:探讨芬太尼和吗啡用于开胸术后镇痛效果及不良反应的观察。方法:356例全麻开胸手术病人,随机分成吗啡治疗组(M组)和芬太尼治疗组(F组),每组178例。F组采用芬太尼100μg+利多卡因200mg+异丙嗪25mg,M组采用吗啡20mg+利多卡因200mg+异丙嗪25mg,分别用生理盐水稀释至100ml,术毕接电子泵行静脉自控镇痛(PCA)。分别记录手术后6、12、24、48h四个时相点两组病人的视觉模拟疼痛评分(VAS评分)、镇静评分(Ramsay评分)以及恶心、呕吐、瘙痒、呼吸抑制等不良反应的发生情况。结果:各时相点F组VAS评分均低于M组,差异显著(p<0.05),而两组间血压、心率、心率、呼吸频率及SpO2无明显差异。各时相点恶心及呕吐评分F组优于M组,两组间差别显著(p<0.05),镇静效果两组相当。两组均未发生严重不良反应。结论:芬太尼用于全麻开胸术后病人的镇痛效果显著强于吗啡,镇静效果与吗啡相当,但不良反应明显小于吗啡,疗效确切,安全性高,值得在推广使用。Objective：To compare the efficacy of fentanil and morphine in patients controlled analgesia（PCA） after thoracotomy.Methods： 356 patients（ASAⅠto Ⅱ） were randomly divided into two groups,group M（treated with an analgesic mixture of morphine） and group F（treated with an analgesic mixture of fentanil）,and 178 cases in each group.PCA was set as a continous dose of 2 ml/h,a bolus dose of 0.5 ml and lock-out time of 20 min in 48h.The visual analogue scale（VAS） and Ramsay sedation score（RSS） and other adverse reactions were assessed at 6, t2, 24 and 48h after operation. Results： Fentanil dose with VAS was significantly different between the two groups during PCA. RSS was significantly higher in group M than that in group F （P〈0.05）. Two groups had no serious adverse reactions. Conclusion： Fentanil has significant analgesic effect,less sedative effect and adverse reactions than morphine. It＇s safer for PCA patients than morphine.

关 键 词：芬太尼 吗啡 自控镇痛 开胸术 

分 类 号：R614[医药卫生—麻醉学]