舒芬太尼、地佐辛和氢吗啡酮治疗腹腔镜胆囊切除术后急性疼痛的效果  

Comparative Analgesic and Side Effects of Sulfentanyl,Dezocine and Hydromorphone in Patients after Laparoscopic Cholecystectomy

作　　者：董璐[1] 莫怀忠[1,2] 刘冬梅[2] 谢刚[1] 刘艳秋[1] 向梅[1,2] 陈伟[2] 

机构地区：[1]贵州医科大学麻醉学系 [2]贵州省肿瘤医院,贵州贵阳550004

出　　处：《贵阳医学院学报》2016年第3期333-336,340,共5页Journal of Guiyang Medical College

摘　　要：目的:观察舒芬太尼、地佐辛和氢吗啡酮对腹腔镜胆囊切除手术(LC)后急性疼痛的疗效。方法:全麻下行LC术患者91例,常规全身麻醉诱导和维持,根据术毕前静脉滴注镇痛药物不同分为SF组(给予舒芬太尼,n=31)、DZ组(给予地佐辛,n=31)和HM组(给予氢吗啡酮,n=29);记录3组患者手术、麻醉、拔管和苏醒时间和拔管即刻(T0)、拔管后10 min(T1)、术后6 h(T2)、术后12 h(T3)及术后24 h(T4)的平均动脉压(MAP)、心率(HR)、疼痛VAS评分、RSS镇静评分和头晕头痛、嗜睡、PONV程度(包括恶心、呕吐)、皮肤瘙痒、尿储留、呼吸抑制等不良反应,记录患者满意度及镇痛药物费用。结果:除SF组拔管及苏醒时间较DZ组和HM组延长(P<0.05)外,3组患者的手术、麻醉时间比较,差异无统计学意义(P>0.05);3组LC手术患者各时点MAP、HR、VAS及RSS评分比较,差异无统计学意义(P>0.05),3组患者术后各时点头晕头痛、嗜睡、恶心呕吐、皮肤瘙痒、尿潴留、呼吸抑制不良反应的发生率比较,差异无统计学意义(P>0.05),SF组和DZ组的PONV程度轻于HM组(P<0.05),SF组的药物费用明显低于DZ组和HM组(P<0.05);SF组、DZ组患者满意度高于HM组(P<0.05)。结论:术毕前滴注镇痛药物均可以防治LC术后急性疼痛,舒芬太尼最适用于临床。Objective： To compare the analgesia efficacy and side effects of sulfentanyl, dezocine and hydromorphone in patients after laparoscopic cholecystectomy （LC）. Methods： Ninety-one patients （ASA Ⅰ - Ⅱ ） scheduled for elective laparoscopic cholecystectomy surgery under general anesthesia were divided into group SF （ sulfentanyl, n = 31 ）, group DZ （ dezocine, n = 31 ） and group HM （hydromorphone, n = 29）. Recording operation time, anesthesia time, extubation time and recovery time. The analgesic efficacy was assessed by Visual analogue pain scale （VAS） and Ramsay sadation scale （RSS） at extubation （To）, 10 min after extubation （T1） and6 h （T2）, 12 h （T3）, 24 h （T4） after operation. Mean arterial pressure （MAP）, Heart rate （HR）, headaches, drowsiness, PONV （Postoperative nausea and vomiting）, itchy skin, urinary retention, postoperative analgesic are recor- ded. The patient overall satisfaction and analgesic drug cost are also recorded. Results： Extubation time in group SF was longer than that in group DZ and group HM and so was the recovery time （ P 〈 0. 05 ）. Operation time, anesthesia time of three groups showed no statistical significance （P 〉 0.05 ） ; MAP, HR, VAS and RSS comparison showed no statistical significance （P 〉 0.05 ）. The incidence ofsomnolence and PONV in HM group was higher than the SF group and DZ group （P 〈 0.05 ）. Other side effects had no statistically significant differences at each time point in the three groups. Compared with HM and DZ group, the other two groups used less additional antiemetic drugs, HM and DZ group showed higher overall satisfaction（P 〈 0.05 ）. Conclusion： All three analgesic drugs can effective in- hibit pain to postoperative patients of laparoscopic cholecystectomy, while sulfentanyl is better than dezocine or hydromorphone for LC postoperative analgesia.

关 键 词：胆囊切除术 腹腔镜 镇痛药 舒芬太尼 地佐辛 氢吗啡酮 疼痛 手术后 

分 类 号：R614.2[医药卫生—麻醉学] R96[医药卫生—外科学]