吗啡联合不同剂量地佐辛用于胸科手术后镇痛的效果研究  

Effect of morphine combined with different doses dezocine in postoperation analgesia of thoracotomy

作　　者：武林鑫[1] 孙海涛[1] 董彦鹏[1] 孙亮[1] 周亮[1] 孙莉[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院麻醉科,北京100021

出　　处：《中国肿瘤临床与康复》2014年第10期1161-1163,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的观察吗啡联合不同剂量的地佐辛应用于胸科术后镇痛的临床效果。方法择期行开胸行肺叶切除手术患者60例,美国麻醉师协会（ASA）分级Ⅰ~Ⅲ级,采用随机数字表法将其分为3组吗啡组（M组）、吗啡＋地佐辛组（MD1组和MD2组）,每组20例。术后镇痛采用持续静脉输注镇痛泵,M组为吗啡0.5 mg·kg^-1·d^-1;MD1组为吗啡0.5 mg·kg^-1·d^-1＋地佐辛0.1 mg·kg^-1·d^-1,MD2组为吗啡0.5 mg·kg^-1·d^-1＋地佐辛0.3mg·kg^-1·d^-1。如镇痛不足,视觉模拟评分法（VAS）〉3或口头评分〉1,则给予补救吗啡3 mg,每次补救用药时间最少间隔10 min,直至VAS〈4或口头评分〈3。观察术后48 h内的VAS评分、口头评分、补救吗啡用量、恶心、呕吐、瘙痒、头晕等不良反应发生率。结果术后48 h内,M组的补救吗啡用量大于MD1组、MD2组（P〈0.05）;M组瘙痒的发生率高于MD1、MD2组（P〈0.05）;MD2组头晕发生率高于M组和MD1组;3组恶心、呕吐的发生率差异无统计学意义。结论较小剂量的地佐辛与吗啡联合应用可增强术后镇痛效果,降低术后瘙痒的发生率,同时不增加其他不良反应的发生率。Objective To observe the effect of morphine combined with dezocine on postoperation analgesic.Methods Sixty adult patients undergoing lobectomy via thoracotomy were randomly assigned to three anesthetic regimens,Group M： group of morphine; Group MD1 and MD2： group of morphine combined with dezocine,each group has 20 subjects enrollment.Anesthesia induction： Sufentanil 0.2 μg·kg-1iv、Propofol 1.5 mg·kg^-1iv、rocuronium 0.6 mg·kg^-1iv; Then sevoflurane expired concentration was kept constant at 1.5% ~ 2.0%,subsequently adjusted according to bispectral index.Sufentanil and rocuronium were titrated to autonomic responses according to hemodynamics and the need of operation.Palonosetron was titrated before the end of surgery at a dose of 0.25 mg.Analgesic method： Group M： morphine was titrated by pump at rate of 0.5 mg·kg^-1·d^-1.Group MD1： morphine 0.5 mg·kg^-1·d^-1＋ dezocine 0.1 mg·kg^-1·d^-1; Group MD2： morphine 0.5mg·kg^-1·d^-1＋ dezocine 0.3 mg·kg^-1·d^-1.If four-point verbal rating scale was greater than 1 or visual analogue scale（ VAS） was greater than 3,rescue morphine was titrated 3mg each time every 10 min after the operation until verbal rating 2 or VAS 3.The rescue morphine requirements and complications during the 48 h after surgery were recorded.Results Rescue morphine consumption： Group M Group MD1 and Group MD2（ P 〈0.05）; Incidence of pruritus： Group M Group MD 1 and Group MD2（ P 〈0.05）; Incidence of dizzy： Group M D2 Group M and Group MD1 The incidence of post operation nausea and vomiting were no differences in three groups（ P 〈0.05）.Conclusion Dezocine at the dose of 0.1 mg·kg^-1·d^-1can enhance the analgesic effect of morphine without increasing other side effects.Furthermore,dezocine administered with morphine may be an effective strategy for preventing morphine induced pruritus.

关 键 词：吗啡 地佐辛 胸科术后镇痛 联合用药 

分 类 号：R614[医药卫生—麻醉学]