酮咯酸氨丁三醇对舒芬太尼用于老年病人术后镇痛的节俭作用  

Sufentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients

作　　者：谢国柱[1] 袁志国[1] 卞丽玉 徐玉民[1] 王荣宁[1] 刘新法[1] 顾政[1] 

机构地区：[1]225330江苏省泰州市人民医院麻醉科

出　　处：《中华麻醉学杂志》2012年第5期573-575,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价酮咯酸氨丁三醇对舒芬太尼用于老年妇科手术病人术后镇痛效果的影响。方法择期妇科开腹手术病人60例，ASA分级Ⅱ或Ⅲ级，年龄≥65岁，体重指数18～24kg／m2，采用随机数字表法，将病人随机分为2组（n=30）：舒芬太尼组（s组）和酮咯酸氨丁三醇混合舒芬太尼组（T组）。采用静吸复合全身麻醉下，术后采用静脉病人自控镇痛，T组镇痛药为酮咯酸氨丁三醇和舒芬太尼，负荷剂量酮咯酸氨丁三醇30mg（手术结束前15min时静脉注射），酮咯酸氨丁三醇180mg混合舒芬太尼100μg稀释至100ml，背景输注速率1．5ml／h，PCA剂量1．6ml，锁定时间20min；S组镇痛药物为舒芬太尼，负荷剂量5μg（手术结束前15min时静脉注射），舒芬太尼100μg稀释至100ml，背景输注速率1．5ml／h，PCA剂量1．6ml，锁定时间20min。术后48h内维持临床有效镇痛（静态和动态VAS评分在3分以下），记录术后48h舒芬太尼用量和不良反应的发生情况。结果与S组比较，T组术后48h舒芬太尼用量减少，不良反应发生率降低（P〈0．05）。结论酮咯酸氨丁三醇可减少舒芬太尼用于老年妇科手术病人术后镇痛的用量，产生显著的节俭作用，提高镇痛的安全性。Objective To evaluate the snfentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients. Methods Sixty ASA Ⅱ or Ⅲ patients, aged I〉65 yr, with a body mass index of 18-24 kg/m2 , undergoing elective gynecological operations, were randomly divided into 2 groups （ n = 30 each） ： sufentanil group （group S） and kctorolac tromethamine plus snfentanil group （group T）. Both groups received combined intravenous-inhalational anesthesia and patient-controlled intravenous analgesia （PCIA） after operation. PCIA solution contained ketorolac tromethamine 180 mg and sufentanil 100μg in 100 ml of normal saline in group T. After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of operation, the PCA pump was set up with a 1.6 ml bolus dose, a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group T- PC1A solution contained sufentanil 100 μg in 100 ml of normal saline in group S. After a loading dose of sufentanil 5μg was injected intravenously at 15 min before the end of operation, the PCA pump was set up with a 1.6 ml bolus dose, a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group S. The effective analgesia （postoperative VAS scores at rest and during activity 〈 3） was maintained with- in 48 h after operation. The amount of snfentanil consumed within 48 h after operation and adverse effects were recorded. Results Compared with group S, the amount of sufentanil consumed within 48 h after operation was significantly reduced, and the incidence of nausea and vomiting, urinary retention and pruritus was significantly decreased in group T （ P 〈 0.05）. Conclusion Ketorolac tromethamine used with PCIA with sufentanil has a significant sufentanil-spafing effect for postoperative analgesia and improves the safety of analgesia in the elderly patients.

关 键 词：酮咯酸氨丁三醇 舒芬太尼 老年人 镇痛 术后 

分 类 号：R614[医药卫生—麻醉学]