吗啡联合地佐辛用于胸科术后镇痛的临床效果  

Effect of morphine combined with dezocine on postoperation analgesia after 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,100021

出　　处：《临床麻醉学杂志》2014年第10期981-983,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察吗啡联合地佐辛用于胸科术后镇痛的临床效果。方法择期行开胸肺叶切除手术患者60例,年龄18~64岁,采用随机数字表法将患者分为三组：吗啡组（M组）、地佐辛组（D组）和吗啡＋地佐辛组（MD组）。术中1.5%~2.0%七氟醚吸入维持麻醉,手术结束前给予盐酸帕洛诺司琼0.25mg。术后连接静脉镇痛泵,M组：吗啡0.5mg·kg-1·d-1;D组：地佐辛0.5mg·kg-1·d-1;MD组：吗啡0.25mg·kg-1·d-1＋地佐辛0.25mg·kg-1·d-1。如VAS评分〉3分或口头疼痛（VRS）评分〉2分,则给予吗啡3mg,每次补救用药时间最少间隔10分钟,直至VAS评分〈4分或VRS评分〈3分。观察术后48h内的VAS评分、VRS评分、术后24、48h补救吗啡用量,及恶心、呕吐、头晕、瘙痒不良反应发生率。结果术后24、48hD组补救吗啡用量明显多于M组（P〈0.05）。术后48hMD组补救吗啡用量明显少于D组（P〈0.05）;M组瘙痒发生率明显高于MD组和D组（P〈0.05）;D组头晕发生率明显高于MD组（P〈0.05）。三组VAS评分、VRS评分差异无统计学意义。结论吗啡联合地佐辛可减少不良反应的发生,对患者术后的康复产生了积极的作用。Objective To observe the effect of morphine combined with dezocine on postoperation analgesic after thoracotomy.Methods Sixty adult patients undergoing lobectomy via thoracotomy were randomly assigned to three anesthetic regimens：group M（group of morphine）;group D（group of dezocine）;group MD（group of morphine combined with dezocine）.Then sevoflurane expired concentration was kept constant at 1.5%-2.0%,subsequently adjusted according to BIS.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.After surgery,morphine was titrated by pump at rate of 0.5mg·kg-1·d-1 in group M.dozocine pumped at 0.5mg·kg-1·d-1.Group MD：morphine 0.25mg·kg-1·d-1＋dezocine 0.25mg·kg-1·d-1 in group D.If four-point verbal rating scale was greater than 2or VAS scores was greater than 3,rescue morphine was titrated 3mg each time every 10 min after the operation until verbal rating〈2or VAS scores〈3.The rescue morphine requirement and complications during the 48 hafter surgery were recorded.Results Rescue morphine consumption during 48hpostoperative：group D〉groups M and MD（P〈0.05）.Incidence of pruritus;group M〉groups MD and D（P〈0.05）.Incidence of dizziness：group D〉group MD（P〈0.05）.There was no differences in the incidence of post operation nausea and vomiting were among the three groups.Conclusion Dezocine administered with morphine provided comparable analgesic effect with less side effects than morphine alone.

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]