盐酸氢吗啡酮联合氟比洛芬酯用于鼻内镜术后自控静脉镇痛的效果  被引量:11

Efficacy of patient-controlled intravenous analgesia with hydromorphone hydrochloride plus flurbiprofen axetil after endoscopic sinus surgery

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作  者:姜雪莺[1] 舒洛娃[1] 潘楚雄[1] 

机构地区:[1]首都医科大学附属北京同仁医院麻醉科,100730

出  处:《中华医学杂志》2017年第32期2516-2519,共4页National Medical Journal of China

基  金:国家自然科学基金(81301131)

摘  要:目的评价盐酸氢吗啡酮联合氟比洛芬酯用于鼻内镜术后自控静脉镇痛(PCIA)的效果。方法选择2015年10月至2016年4月北京同仁医院择期行鼻内镜手术的患者100例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,全静脉麻醉,术后使用自控静脉镇痛。根据镇痛配方将患者分为3组:A组:盐酸氢吗啡酮1μg·kg^-1·h^-1+氟比洛芬酯200mg;B组:盐酸氢吗啡酮2μg·kg^-1·h^-1;C组:盐酸氢吗啡酮1μg·kg^-1·h^-1。各组PCIA泵中药物剂量按50h计算,将所配置药物用生理盐水稀释到100ml,背景输注均设为2ml/h,追加剂量为2ml,锁定时间为15min。记录术后1、4、8、12、24、48h各时间点患者的疼痛视觉模拟评分(VAS)、Ramsay镇静评分,48h内镇痛泵按压次数及不良反应发生率。结果A组术后1、4、8、12h的VAS评分分别为(1.9±0.6)、(1.8±0.6)、(1.6±0.6)、(1.2±0.4)分,B组分别为(1.8±0.4)、(1.7±0.7)、(1.6±0.6)、(1.3±0.5)分,C组分别为(2.5±0.9)、(2.1±0.6)、(2.0±0.6)、(1.8±0.5)分,差异均有统计学意义(F=8.661、3.105、4.903、13.846,均P〈0.05);其中A组与B组相当(均P〉0.05),较C组低(均P〈0.05);48h内镇痛泵按压的次数A组为(1.4±1.0)次,少于C组的(2.2±1.8)次,差异有统计学意义(P〈0.05);A组术后1、4、8h的Ramsay镇静评分分别为(2.4±0.6)、(2.2±0.6)、(2.2±0.4)分,B组分别为(2.8±0.7)、(2.6±0.7)、(2.4±0.6)分,C组分别为(2.3±0.6)、(2.1±0.4)、(2.1±0.2)分,差异均有统计学意义(F=5.660、6.782、7.141,均P〈0.05);其中A组与C组相当(均P〉0.05),较B组低(均P〈0.05);A组不良反应总发生率为8.8%,与C组的9.1%相当(X2=0.001,P〉0.05),明显少于B组的42Objective To evaluate the efficacy of patient-controlled intravenous analgesia (PCIA) with hydromorphone hydrochloride plusflurbiprofen axetil after endoscopic sinus surgery (ESS). Methods One hundred patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for ESS under total intraveous anesthesia with postoperative PCIA in Beijing Tongren Hospital from October 2015 to April 2016 were randomly divided into 3 groups according to the different formula of PCIA pumpin each group : Group A ( hydromorphone hydroehloride 1 μg·kg^-1·h^-1 ± flttrbiprofen axetil 200 nag) , Group B (hydromorphone hydrochloride 2μg·kg^-1·h^-1), Group C( hydromorphone hydrocbloride 1μg·kg^-1·h^-1). The dosage of PCIA in each group was calculated for 50 h, and was diluted in 100 ml normal saline. All the pump was set up background infusion at a rate of 2 ml/h with a 2 m] bolus dose and a 15 min lock-time. Visual analogue scale (VAS) and Ramsay sedation scores at time points of postoperative 1,4, 8, 12, 24, 48 h, the number of attempts to press bolus and rate of adverse effects within 48 h were recorded. The differences were compared among the groups. Results VAS at postoperative 1,4, 8, 12 h in Group A was (1.9±0.6), (1.8±0.6), (1.6±0.6), and (1.2±0.4) respectively, in GroupBwas (1.8±0.4),( 1.7 ±0. 7), ( 1.6 ± 0. 6), and ( 1.3 ± 0. 5 ) respectively, in Group C was (2. 5 ± 0.9), ( 1.7 ± 0. 7 ), ( 1.6 ± 0. 6), and ( 1.3 ± 0. 5) respectively. The difference among each group were statistically significant (F = 8. 661, 3. 105, 4. 903, 13. 846, P 〈 0. 05). VAS in Group A was similar to that in Group B ( P 〉 0. 05 ), but was lower than that in Group C ( P 〈 0. 05). The number of attempts to press bolus within 48 h in group A was 1.4 ± 1.0, which was less than in Group C (2. 2 ± 1.8 , P 〈 0. 05). Ramsay sedation score at postoperative 1,4, 8 h in Group A was (2.4 ± 0. 6), (2. 2 ± 0. 6), and

关 键 词:氟比洛芬酯 氢吗啡酮 镇痛 病人控制 内窥镜 

分 类 号:R614[医药卫生—麻醉学]

 

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