三种药物对复杂性肛瘘术后镇痛效果的临床观察  

Clinical observation for the analgesic effect of three drugs on complex anal fistula after operation

作　　者：高相山[1] 王守义[1] 陶清[1] 王明[2] 陈庆一[1] 

机构地区：[1]安徽省中医院麻醉科,合肥230031 [2]安徽省中医院手术室,合肥230031

出　　处：《临床医学》2014年第10期22-24,共3页Clinical Medicine

摘　　要：目的比较三种药物应用于复杂性肛瘘术患者的镇痛效果及不良反应。方法复杂性肛瘘患者90例,ASAⅠ～Ⅱ级,年龄15～65岁,体质量42～85 kg。随机分为三组：S组：舒芬太尼（100μg）＋左布比卡因（200 mg）;O组：羟考酮（20 mg）＋左布比卡因（200 mg）;M组：氢吗啡酮（2 mg）＋左布比卡因（200 mg）。术后行患者自控的硬膜外镇痛（PCEA）。术后12 h（T1）、24 h（T2）、48 h（T3）对患者进行疼痛视觉模拟评分（VAS）;并询问患者对术后镇痛的满意度;询问并记录相关不良反应如：恶心、呕吐、皮疹瘙痒、体位性头晕、头晕、情绪改变、失眠或嗜睡、尿潴留、口干及其他不良反应。结果在T1及T2时点,与S、O组比较,M组的术后镇痛有效性明显提高（P〈0.05）;T3时点,三组镇痛有效性比较差异无统计学意义（P〉0.05）。三组间各种不良反应比较差异无统计学意义（P〉0.05）。与S、O组比较,M组的满意程度最高,差异有统计学意义（P〈0.05）;与S组比较,O组的满意程度较高,差异有统计学意义（P〈0.05）;三组不满意程度比较差异无统计学意义（P〉0.05）;而可接受程度三组之间比较O组最高,差异有统计学意义（P〈0.05）。结论氢吗啡酮联合左布比卡因适用于肛瘘患者的PCEA,镇痛效果优于舒芬和羟考酮,且不良反应比较差异无统计学意义。Objective To compare the analgesia effects and side effects of the three drugs on patients with complex anal fistu- la after operation. Methods Ninety cases of complex anal fistula patients, ASA I - II, aged 15 - 65 years, body weight 42 - 85 kilograms. Patients were randomly divided into three groups： group S： sufentanil （100 ~g） ＋ levobupivacaine （200 mg）; group O ： oxycodone （ 20 mg） ＋ levobupivacaine （ 200 mg） ; group M ： hydromorphone （ 2 mg） ＋ levobupivacaine （ 200 rag） , postop- erative PCEA. The pain visual analogue scale （VAS） and postoperative analgesia satisfaction were observed and recorded at the time point of 12 （ T1 ） , 24 （ T2 ）, 48 hours （ T3 ） after operation ; the related adverse reactions such as nausea, vomiting, rash, pruritus, orthostatic dizziness, dizziness, mood changes, insomnia or hypersomnia, retention of urine, dry mouth, and other ad- verse reaction were recorded. Results At the time point of T1 and T2, compared with group S and group O, the postoperative analgesic effect increased significantly in group M （ P 〈 0.05 ） ; At the time point of T3, the analgesia effectiveness in the three groups had no significant difference （P 〉 0. 05 ）. The various adverse reactions had no significant difference in the three groups （P 〉 0. 05）. Compared with group S and group O, the degree of satisfaction in group M was the highest, the difference was statistically significant （ P 〈 0. 05 ） ; compared with group S, the degree of satisfaction in group O was higher, the difference was statistically significant （ P 〈 0. 05 ） ; the dissatisfaction in the three groups had no significant difference （ P 〉 0. 05 ） ; the acceptable level in group 0 was the highest, the difference was significant （P 〈 0. 05 ）. Conclusion The hydromorphone combined with levobupivacaine is appropriate tbr patients with complex anal fistula after operation in PCEA, the analgesic effect is better than sufentanil and oxycodone, whereas t

关 键 词：舒芬太尼 羟考酮 氢吗啡酮 患者自控的硬膜外镇痛 

分 类 号：R614[医药卫生—麻醉学]