地佐辛与芬太尼不同剂量配伍腰椎手术后患者自控静脉镇痛对应激反应的影响  

Clinical effect of patient controlled intravenous analgesia with different dose of dezocine and fentanyl on stress response post vertebral operation

作　　者：左灵[1,2] 吕艳霞[1] 刘春盛 李晓鸿 李新巾 

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051 [2]冀中能源邢台矿业集团总医院麻醉科

出　　处：《疑难病杂志》2015年第6期611-614,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的：观察地佐辛与芬太尼不同剂量配伍用于腰椎手术后患者自控静脉镇痛（PCIA）对应激反应的影响。方法全麻下行腰椎手术患者200例，男124例，女76例，年龄35～50岁，体质量60～70 kg，ASA I～II级，按随机数字表法分为5组，每组40例。各组PCIA泵药物配制为：芬太尼（F）组为芬太尼18μg／kg，配伍1（DF1）组为地佐辛0．3 mg／kg＋芬太尼12μg／kg，配伍2（DF2）组为地佐辛0．45 mg／kg＋芬太尼9μg／kg，配伍3（DF3）组为地佐辛0．6 mg／kg＋芬太尼6μg／kg，地佐辛（D）组为地佐辛0．9 mg／kg，每组泵中均加入昂丹司琼8 mg和生理盐水共配制成100 ml，各组背景输注速率2 ml／h。于术后2、6、12、24及48 h采用视觉模拟评分法（ VAS评分）评价镇痛效果，并于入手术室后10 min及术后2、6、24 h采集静脉血测定血糖（ Glu）及血浆皮质醇（ Cor）、肾上腺素（ E）和去甲肾上腺素（ NE）的浓度。结果与F、D组比较，DF1、DF2、DF3组术后2、6、12 h及24 h VAS评分和术后2、6及24 h Glu、血浆Cor、E、NE浓度均降低（ P ＜0．05或0．01）；与DF1和DF3组比较，DF2组术后2、6、12及24 h VAS评分和术后2、6和24 h Glu、血浆Cor、E、NE浓度均降低（ P ＜0．05或0．01）。结论地佐辛与芬太尼不同剂量配伍PCIA镇痛效果及减轻术后应激反应作用均优于二者单独应用，且以配伍2（DF2）组应激反应最低。Objective To observe the compatibility of different dose dezocine and fentanyl for lumbar surgery patient controlled intravenous analgesia （ PCIA） on stress response effect.Methods Under general anesthesia lumbar spinal surgery patients of 200 cases, 124 cases were male, 76 cases were female, age 35-50 years old, the body weight was 60-70 kg, ASA I-II, they were randomly divided to 5 groups, 40 cases in each group.Each group of PCIA drug preparation： fentanyl group （F Group） for fentanyl 18 g /kg, compatibility 1 （DF1） group dezocine 0.3 mg /kg ＋fentanyl 12 g /kg, compati-bility 2 （DF2） group dezocine 0.45 mg /kg ＋fentanyl 9 g /kg, compatibility 3 （DF3） group for dezocine 0.6 mg /kg ＋fentanyl 6 u g /kg.（ D） dezocine group dezocine 0.9 mg /kg, each pump was added to ondansetron Joan 8 mg and normal saline were prepared into 100 ml, each background infusion rate was 2 ml /h.After 2, 6, 12, 24 and 48 h, using visual ana-logue scale （VAS） to evaluate the effect of analgesia, and after entering the operation room 10 min after operation and 2, 6, 24 h collected venous blood determination of blood glucose （ Glu） and plasma cortisol （ Cor） , epinephrine （ E） and the con-centration of norepinephrine （NE）.Results Compared with F, D group, DF1, DF2, DF3 group after 2, 6, 12 h and 24 h, VAS score and 2, 6, and 24 h after operation’ s Glu, plasma Cor, E and NE concentration were decreased （ P 〈0.05 or 0.01）;and compared DF1 and DF3 group, DF2 group after 2, 6, 12, and 24 h, VAS rating and 2, 6 and 24 h after opera-tion’s Glu, plasma Cor, E and NE concentration were decreased （ P 〈0.05 or 0.01）.Conclusion Dezocine and fentanyl different doses combined with PCIA’ s analgesia effect and reduce postoperative stress reaction were better than the two sepa-rate application, and DF2 group’ s stress response are the lowest.

关 键 词：地佐辛 芬太尼 静脉自控镇痛 应激反应 

分 类 号：R614[医药卫生—麻醉学]