不同药物配伍用于肛门部手术后静脉镇痛的临床观察  

Efficacy of different drug compatibility regimens for postoperative intravenous analgesia of anus operation

作　　者：胡琼玉[1] 桂育琴 张泽元 李林桂 靳三庆[1] 

机构地区：[1]中山大学附属第六医院,广东广州510655

出　　处：《现代医院》2017年第10期1536-1540,共5页Modern Hospitals

摘　　要：目的观察不同静脉药物配伍方案应用于肛门部手术术后镇痛的效果及不良反应。方法将80例拟在腰硬联合麻醉下行择期肛门部手术患者随机分成A组(氟比洛芬酯100 mg/d+右美托咪定100 ug/d)和B组(氟比洛芬酯100 mg/d+地佐辛10 mg/d),每组40例。术后镇痛时间均为48 h。分别记录两组麻醉诱导前(T_0)、术毕即刻(T_1)、术毕15 min、30 min、45 min、60 min、4 h、8 h、12 h、24 h、48 h(T_2-T_(10))的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(Sp O2);T_1、T_6-T_(10)各时间点疼痛视觉模拟(VAS)评分、病人自控镇痛(PCA)的次数、Ramesay镇静评分;记录镇痛过程中不良反应(恶心、呕吐、尿潴留等)的发生率;患者对此次术后镇痛的舒适度评价。结果两组患者在各观察时间点HR、SBP、DBP、SpO_2、VAS评分、PCA的次数、Ramesay镇静评分比较差异无统计学意义(P>0.05)。A组患者恶心和尿潴留的发生率明显低于B组(恶心:0%vs 15%,P<0.05;尿潴留:5%vs 20%,P<0.05),舒适度明显优于B组(P<0.05)。结论右美托咪定或地佐辛复合氟比洛芬酯应用于肛门部手术术后静脉镇痛均能发挥良好镇痛效果,对血流动力学、呼吸和意识影响较小。但右美托咪定复合氟比洛芬酯的恶心和尿潴留发生率更低,舒适度更高。Objective To investigate the efficacy and adverse effect of different drug compatibility regimens for postoperative intravenous analgesia of anus operation. Methods Eighty patients scheduled for anus operation under combined spinal epidural anesthesia were divided into two groups,which were maintained using flurbiprofen axetil 100 mg/d ＋ dexmedetomidine 100 ug/d（ group A） or flurbiprofen axetil 100 mg/d ＋ dezocine 10 mg/d（ group B） for 48 h-postoperative intravenous analgesia. Heart rate（ HR）,systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and SpO_2 before anesthetic induction（ T_0）,at the end of operation（ T_1）,at 15 min,30 min,45 min,60 min,4 h,8 h,12 h,24 h and 48 h（ T_2-T_（10）） after operation were recorded. Visual analogue scale（ VAS） score,patient-controlled analgesia（ PCA） frequency and Ramsay sedation score were recorded at T_1,T_6-T_（10）. Adverse effects,including nausea,vomit,uroschesis,and et al. were recorded during the process of postoperative analgesia. Comfort grade was evaluated at the end of postoperative analgesia. Results There was no difference between the two groups on HR,SBP,DBP,VAS score,PCA frequency and Ramsay sedation score（ P〉 0. 05）. But the incidences of nausea,and uroschesis in group A were lower than group B（ nausea： 0% vs 15%,P 〈0. 05; uroschesis： 5% vs 20%,P 0. 05）. The patients in group A had higher comfort grade than group B（ P 〈0. 05）. Conclusion Dexmedetomidine or dezocine combined flurbiprofen axetil both have a confirmed postoperative analgesic effect for anus operation with few influence on circulation,respiratory. But Dexmedetomidine combined flurbiprofen axetil has fewer adverse effcet such as nausea and uroschesis,and higher comfort grade,which deserves clinical spread value.

关 键 词：右美托咪定 地佐辛 肛门手术 静脉自控镇痛 

分 类 号：R681.7[医药卫生—骨科学]