舒芬太尼配伍曲马多用于女性腹腔镜胆囊切除术和妇科腹腔镜手术术后自控静脉镇痛效果的比较  

Comparison of sufentanil-tramadol PCIA between laparoscopic cholecystectomy and gynecological laparoscopy

作　　者：郭珊娜 段光友[1] 王金韬[1] 迟晓慧[1] 张莉[1] 张咸伟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《中华外科杂志》2015年第2期150-154,共5页Chinese Journal of Surgery

摘　　要：目的 比较女性患者腹腔镜下胆囊切除术和妇科腹腔镜手术术后自控静脉镇痛（PCIA）效果的差异.方法 回顾性分析2011年1月至2012年7月在华中科技大学同济医学院附属同济医院接受腹腔镜下胆囊切除术和妇科腹腔镜手术（腹腔镜下卵巢囊肿剥除术或子宫肌瘤切除术）的645例女性患者的临床资料,其中使用舒芬太尼配伍曲马多PCIA的患者207例.按手术类型分为两组：腹腔镜胆囊切除术组（n=77）和妇科腹腔镜手术组（n=130）.分别采用t检验、x2检验、Fisher精确检验或非参数检验比较两组术后4～6h、8～12h、18 ～24 h视觉模拟评分（VAS）,以及术后PCIA有效按压次数、药物总消耗量及不良反应发生情况.结果 两组患者年龄、体重指数、手术时间的差异无统计学意义（P值均＞0.05）.腹腔镜胆囊切除术组有效按压次数[5（7）次]略高于妇科腹腔镜手术组[3（4）次],但差异无统计学意义（Z=-1.747,P=0.081）.腹腔镜胆囊切除术组PCIA药物总消耗量为79（33）ml,高于妇科腹腔镜手术组的48（30） ml（Z=-6.267,P=0.000）.两组患者4～6h、8～12h、18～ 24 h VAS差异无统计学意义（P＞0.05）.两组患者不良反应总发生率差异亦无统计学意义（腹腔镜胆囊切除术组为11.7％,妇科腹腔镜手术组为16.2％）（x2=0.778,P =0.378）.但妇科腹腔镜手术组眩晕的发生率（6.2％）高于腹腔镜胆囊切除术组（0）（Fisher精确检验：P ＜0.05）.结论 舒芬太尼配伍曲马多用于两种手术PCIA时,腹腔镜胆囊切除术术后镇痛药物需要量更高,妇科腹腔镜手术术后眩晕的发生率更高.Objective To compare the differences of postoperative patient-controlled intravenous analgesia for laparoscopic cholecystectomy and gynecological laparoscopy in female patients.Methods This retrospective study included 645 female patients received laparoscopic cholecystectomy or gynecological laparoscopy（laparoscopic oophorocystectomy/myomectomy） between January 2011 and July 2012 in Tongji Hospital.Among them,207 cases of sufentanil-tramadol patient-controlled intravenous analgesia（PCIA） were enrolled and divided into 2 groups：77 cases in laparoscopic cholecystectomy group,and 130 cases in gynecological laparoscopy group.The pressing frequency and consumption of PCIA,localization and quality of postoperative pain,visual analogue scale （VAS） at 4-6 h,8-12 h,18-24 h after surgery,and adverse effect were compared by t-test,x2 test,Fisher exact test or Mann-Whitney test.Results There was no statistical difference of age,body mass index,and operation time between the two groups （all P 〉 0.05）.As compared with the gynecological laparoscopy group （3 （4））,PCIA pressing frequency was higher in the laparoscopic cholecystectomy group （5 （7））,but there was no statistical difference （Z =-1.747,P =0.081）.PCIA consumption in the laparoscopic cholecystectomy group（79 （33）ml） was higher than that in the gynecological laparoscopy group （48 （30） ml） （Z =-6.267,P =0.000）.The postoperative pain localization and quality were different in the two groups,the patients in the laparoscopic cholecystectomy group experienced dull pain in lower abdomen,but the ones in the gynecological laparoscopy group had distending pain in upper abdomen and piercing pain around scapula.The differences of 4-6 h,8-12 h,18-24 h VAS scores in the two groups had no statistical significance（all P 〉 0.05）.The total incidence of postoperative adverse effect between the two groups had no statistical significant difference （laparoscopic cholecystectomy group：11.7%,gynecological laparoscopy group�

关 键 词：舒芬太尼 曲马朵 镇痛 病人控制 胆囊切除术 腹腔镜 妇科外科手术 

分 类 号：R614[医药卫生—麻醉学]