氯诺昔康复合芬太尼用于全膝关节置换术后病人自控静脉镇痛  

Postoperative patient-controlled intravenous analgesia with lornoxicam and fentanyl in patients undergoing total knee replacement

作　　者：张蓬勃[1] 张珍妮[1] 刘鹏斌[1] 宋正川[1] 吴刚[1] 白洁[1] 

机构地区：[1]西安交通大学医学院第二附属医院麻醉科

出　　处：《山西医科大学学报》2010年第8期727-730,共4页Journal of Shanxi Medical University

基　　金：陕西省科技计划项目[2007K15-01(17)]

摘　　要：目的观察氯诺昔康复合不同剂量芬太尼在全膝关节置换术后患者自控静脉镇痛（PCIA）的效果。方法 45例全膝关节置换术患者,均采用静吸复合全麻,术后根据镇痛方式不同分为3组,每组15例：A组给予芬太尼0.3μg/（kg.h）;B组给予氯诺昔康15μg/（kg.h）＋芬太尼0.25μg/（kg.h）;C组给予氯诺昔康15μg/（kg.h）＋芬太尼0.2μg/（kg.h）。各组均加0.9%氯化钠溶液稀释至100ml,PCIA背景输注速率2ml/h,自控流量0.5ml/15min。观察患者术后4h,8h,24h,48h视觉模拟评分（VAS）,记录平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏氧饱和度（SpO2）及不良反应。结果 A、B两组术后4h,8h,24h的VAS评分低于C组（P〈0.05）,三组患者术后各时点MAP、HR、RR、SpO2差异无统计学意义（P〉0.05）,A组恶心、嗜睡的发生率较其他两组有增加趋势。三组患者均未出现头晕、呼吸抑制及消化道出血等不良反应。结论氯诺昔康复合芬太尼用于全膝关节置换术后患者PCIA效果确切,并可以减少芬太尼的用量及其不良反应的发生率。Objective To explore the effects of lornoxicam and fentanyl on postoperative patient-controlled intravenous analgesia（PCIA）in patients undergoing total knee replacement.Methods Forty-five patients undergoing total knee replacement were divided into 3 groups：fentanyl[0.3 μg/（kg·h）] group,lornoxicam[15 μg/（kg·h）]＋fentanyl 0.25 μg/（kg·h）group,lornoxicam[15 μg/（kg·h）]＋fentanyl（0.2 μg/（kg·h）group.All the anesthetic agents were diluted to 100 ml using 0.9% sodium chloride solution.PCIA was set at 2 ml/h with bolus dose of 0.5 ml/15 min.Visual analogue score（VAS）,mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,pulse oxygen saturation（SpO2）and adverse effects were determined and compared at 4 h,8 h,24 h and 48 h after operation.Results Visual analogue scale（VAS）were lower in fentanyl group and lornoxicam＋fentanyl 0.25 μg/（kg·h）group than in lornoxicam＋fentanyl（0.2 μg/（kg·h）group at 4 h,8 h and 24 h after the operation（P〈0.05）.No significant difference was detected in MAP,HR,RR,SpO2 and MAP at each time point among the three groups（P〈0.05）.The incidence of nausea and lethargy in fentanyl group was higher than that in the other two groups.Conclusion Patient-controlled intravenous analgesia with lornoxicam and fentanyl in patients undergoing total knee replacement has analgesics effect,with less dose of fentanyl and less adverse effects.

关 键 词：病人自控静脉镇痛 芬太尼 氯诺昔康 全膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]