等效剂量地佐辛与吗啡复合氟比洛芬酯用于妇科手术后镇痛效果比较  

Comparation of dezocine and morphine for postoperative analgesia combined with Flurbiprofen after gynecological surgery

作　　者：王晓娜[1] 殷玲[1] 刘宏伟[1] 于泳浩[1] 

机构地区：[1]天津医科大学总医院麻醉科,300052

出　　处：《中国综合临床》2012年第3期325-328,共4页Clinical Medicine of China

摘　　要：目的比较等效剂量地佐辛与吗啡联合氟比洛芬酯用于妇科子宫全切术后镇痛的效果及安全性。方法择期开腹全子宫切除术患者90例，美国麻醉师协会（ASA）Ⅰ～Ⅱ级，随机分为3组：分别使用地佐辛50mg＋氟比洛芬酯100mg（D组）、吗啡50mg＋氟比洛芬酯100nag（M组）、地佐辛25mg＋吗啡25mg＋氟比洛芬酯100mg（DM组）。术后均使用持续输注静脉镇痛泵（2ml／h）。患者采用咪达唑仑、依托咪酯、芬太尼、顺苯磺阿曲库铵诱导，异丙酚＋瑞芬太尼维持麻醉，手术结束前15—30min静脉给予氟比洛芬酯50mg。镇痛效果不满意时肌肉注射吗啡5mg／次。记录患者术后4、8、24、48h静息状态和活动状态下的疼痛视觉模拟评分、RamSay镇静评分、48h内吗啡的用量以及恶心、呕吐、皮肤瘙痒、呼吸抑制等副作用。结果患者术后4、8、24、48h的疼痛视觉模拟评分静息状态时D组[分别为2．27±0．64、2．17±0．65、1．97±0．67、1．60±0．56]、DM组[分别为2．50±0．63、2．40±0．62、2．204-0．61、1．87±0．57]和活动状态时[D组分别为3．10±0．76、2．97±0．76、2．70±0．84、2．17±0．70；DM组分别为3．43±0．63、3．30±0．65、3．03±0．76、2．43±0．68]均低于M组[静息状态时分别为3．10±0．76、3．00±0．74、2．80±0．71、2．40±0．72；活动状态时分别为4．13±0．94、3．93±1．05、3．60±1．05、3．03±0．96]，差异均有统计学意义（P均〈0．01）。术后48h内镇静评分，D组患者优于M组（x^2=4．812，P〈0．05）。术后48h内的不良反应D组为26．7％、DM组为46．7％，较M组（80．0％）少，差异有统计学意义（x^2=17．431，P〈0．01）：结论地佐辛50mg＋氟比洛芬酯100mg术后持续镇痛48h效果优于等效剂量吗啡或地佐辛与吗啡联合应用，且副作用明显减少。Objective To compare the efficiency and safety of dezocine and morphine combined with flurbiprofen for gynecologic postoperative analgesia. Methods Ninty patients for elective hysterectomy, ASA （American Society of Anesthesiologists） Ⅰ - Ⅱ , were randomly divided into three groups, given postoperative intravenous analgesic pump：dezocine 50 mg ± flurbiprofen 100 mg （Group D） ;morphine 50 mg ± flurbiprofen 100 mg （Group M） ;dezocine 25 mg ± morphine 25 mg ± flurbiprofen 100 mg （Group DM ）. Anesthesia were induced by midazolam,etomidate,fentanyl and cisatracurium,maintained with propofol and remifentanil. At 15 - 30 min before the end of surgery, flurbiprofen 50 mg was given,if pain was not relieved statsifically, morphine 5 mg/per time was given additionally. VAS Pain relief scores, Ramsay sedation Score, usage of morphine and side effects such as nausea, vomiting and itch of skin were recorded at 4,8,24,48 h after surgery. Results At 4,8, 24 and 48 h after surgery, VAS score at sedation was （2. 27 ± 0. 64）, （ 2. 17 ± 0. 65 ）, （ 1.97 ± 0. 67 ）, and （ 1.60 ± 0. 56） in Group D, and （2. 50 ± 0. 63 ）, （2. 40 ± 0. 62）, （2. 20 ± 0. 61 ） and （ 1.87 ± 0.57 ） in Group DM at sedation,which were all significantly low than those of （3.10 ±0. 76）, （3.00 ±0. 74）, （2. 80 ±0.71 ） and （2.40 ± 0. 72 ）in Group M. At 4,8,24 and 48 h after surgery, VAS score at active was （3.10 ± 0. 76 ）, （2. 97 ±0. 76）, （2. 70 ±0. 84）and （2. 17 ±0. 70）in Group D, （3.43 ±0. 63）, （3.30 ±0. 65）, （3.03 ±0. 76） and （2.43 ± 0. 68 ）in Group DM, which were all significantly lower than those of （4. 13 ± 0. 94 ）, （3.93 ± 1.05 ）, （3.60 ± 1.05 ） and （ 3.03 ± 0. 96 ） in Group M （ Ps 〈 0. 05 ）. And the VAS scores of Group DM was significantly higher than those of Group D. Sedation score at 48 h after surgery in group D was better than that in Group M （ X2 = 4. 812, P 〈 0.05 ）, The side effects at 48 h after su

关 键 词：术后镇痛 地佐辛 吗啡 子宫切除术 

分 类 号：R614[医药卫生—麻醉学]