瑞芬太尼在痔上黏膜环切术患者自控镇痛中的应用  

Application of remifentanil in patient - controlled analgesia for patients with procedure for prolapse and hemorrhoids

作　　者：朱丽璇[1] 金华[1] 宁杰[1] 李艳华[1] 

机构地区：[1]云南省第一人民医院麻醉科,云南昆明650032

出　　处：《中国新药与临床杂志》2013年第3期200-203,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：云南省应用基础研究计划项目(2008ZC082M)

摘　　要：目的观察瑞芬太尼用于痔上黏膜环切术(PPH)患者自控镇痛的安全性和有效性。方法 90例ASAⅠ或Ⅱ级拟行PPH的环状混合痔患者,随机分为局麻组(L组)、硬膜外麻醉组(EA组)和患者自控镇痛组(PCA组),每组30例。L组以1.73%利多卡因15～20 mL行局部麻醉。EA组于L3～L4行硬膜外穿刺置管,以2%利多卡因3 mL作为试验剂量,1.73%利多卡因10～15 mL作为诱导剂量。PCA组,瑞芬太尼负荷剂量0.8～1.0μg.kg-1,维持剂量0.03～0.06μg.kg-1.min-1;PCA剂量20μg,锁定时间2 min。观察患者生命体征变化、血糖值和镇痛效果,记录麻醉、手术操作时间和不良反应。结果与L组相比,EA组和PCA组VAS评分低,患者和术者满意度高(P<0.05),EA组和PCA组组间无显著差异(P>0.05)。与L组相比,EA组和PCA组术中生命体征和血糖稳定。三组手术操作时间无显著差异(P>0.05),EA组麻醉操作时间长于L组和PCA组(P<0.05)。L组肛周疼痛和不良体动发生率(80%和47%)高于EA组、PCA组(3%和0、7%和3%,P<0.05),EA组术后尿潴留发生率(17%)高于L组、PCA组(均为3%,P<0.05)。结论瑞芬太尼PCA技术用于PPH患者镇痛效果好、安全易行,值得在临床推广应用。AIM To observe the safety and feasibility of remifentanil in patientcontrolled analgesia （PCA） for patients with procedure prolapse and hemorrhoid （PPH）. METHODS Ninety patients with ASA I - Ⅱ undergoing PPH were divided into three groups： local anesthesia group （group L）, epidural anesthesia group （group EA） and group PCA, 30 in each. In the group L, 1.73% lidocaine 15 - 20 mL was injected as local anesthesia. Patients in the group EA were punctured at L3 - L4 and injected with lidocaine （2% lidocaine3 mL for test and 1.73% lidocaine 10 - 15 mL for anesthesia induction）. In the group PCA, remifentanil was infused by PCA system： loading dose 0.8 - 1.0μg.kg-1 ＋ maintenance dose 0.03 - 0.06 μg.kg-l＂min-1 ＋ PCA dose 20 μg, lock time 2 rain. The vital signs, blood glucose levels, analgesic effects, anesthesia time, operation time and adverse drug reactions were recorded. RESULTS Compared with the group L, visual analogue scales （VAS） in the group EA and PCA were lower （P 〈 0.05）, and satisfactory degree of patients and surgeons were higher （P 〈 0.05）, no significant differences between the group EA and PCA （P 〉 0.05）. Compared with the group L, vital signs and blood glucose levels were more stability in the group EA and PCA. There was no significant difference in operation time among three groups （P 〉 0.05）. The anesthesia time in the group EA was longer than those in the group L and PCA （P 〈 0.05）. The incidences of perianal pain and bad body movement in the group L （80% and 47% ） were more than those in the group EA and PCA （3% and 0, 7% and 3%, P 〈 0.05）. The rate of urine store leave in the group EA （17%） was more than those in the group L and PCA （3% and 3%, P 〈 0.05）. CONCLUSION PCA with remifentanil for PPH can be achieved effectively, painlessly and safely, and it is worth extending in clinic practice.

关 键 词：瑞芬太尼 镇痛 病人控制 痔 痔上黏膜环切术 

分 类 号：R971[医药卫生—药品]