盐酸丙帕他莫辅助芬太尼患者自控镇痛对脊柱手术患者术后疼痛和恶心呕吐的影响  

The effect of patient-controlled analgesia with propacetamol-fentanyl for prevention of postoperative pain and nausea and vomitingin patients undergoing spinal surgery

作　　者：何含 刘群[1] 钟庆[1] 翁艳[1] 汪艳 黄凡 邬瑞刚 杨国仁[1] HE Han;LIU Qun;ZHONG Qing;WENG Yan;WANG Yan;HUANG Fan;WU Ruigang;YANG Guoren(Department of Anesthesiology and Pain Medicine,Jianyang People′s Hospital,Jianyang,Sichuan 641400,China)

机构地区：[1]简阳市人民医院麻醉疼痛科,四川641400

出　　处：《现代医药卫生》2019年第9期1303-1307,共5页Journal of Modern Medicine & Health

基　　金：简阳市人民医院科研基金重点项目(JY201708;JY201802)

摘　　要：目的观察脊柱手术后持续输注盐酸丙帕他莫辅助芬太尼为基础的患者自控镇痛(PCA)方案对术后镇痛效果和恶心呕吐(PONV)发生率的影响。方法选取行脊柱手术的非吸烟女性患者90例作为研究对象,将其随机分为盐酸丙帕他莫组(n=47)和对照组(n=43),术后分别在PCA中加入盐酸丙帕他莫(4g)或同等体积的生理盐水,再加入生理盐水稀释至100mL。记录患者术后视觉模拟评分(VAS评分)、PONV发生率,以及术后不良反应发生情况。结果盐酸丙帕他莫组患者在术后大于6～12h、>12～24h静息时VAS评分低于对照组,差异有统计学意义(P<0.05);活动时2组患者VAS评分比较差异无统计学意义(P>0.05);0～24h总量、术后大于12～24h使用补救镇痛药例数少于对照组,差异有统计学意义(P<0.05);使用芬太尼作为补救镇痛药物剂量低于对照组,差异有统计学意义(P<0.05);患者术后0～24h总量、术后大于6～12h、术后大于12～24h补救镇痛药物换算吗啡量低于对照组,差异有统计学意义(P<0.05)。盐酸丙帕他莫组患者术后0～24h发生恶心的总例数少于对照组,差异有统计学意义(P<0.05);2组患者术后恶心的程度和使用补救镇痛药例数比较差异均无统计学意义(P>0.05)。2组患者PCA方案总消耗量和换算吗啡用量比较差异均无统计学意义(P>0.05)。盐酸丙帕他莫组患者术后满意度评分高于对照组,差异有统计学意义(P<0.05)。2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论脊柱手术后持续输注盐酸丙帕他莫应用于术后PCA,能减轻术后疼痛,减少PONV的发生,患者满意度高,且不会增加不良反应的发生率。Objective To observe the effect of continuous infusion of propatanol-assisted fentanyl-based patient-controlled analgesia (PCA) regimen on postoperative analgesia and incidence of nausea and vomiting (PONV) after spinal surgery. Methods Ninety non-smoking female patients who underwent spinal surgery were randomly divided into the propacetaside group ( n =47) and the control group ( n =43).After the operation,propaphene hydrochloride (4 g) or the same volume of physiological saline was added to the PCA,and then diluted to 100 mL with physiological saline.The postoperative visual analogue scale (VAS score),the incidence of PONV,and the incidence of postoperative adverse reactions were recorded. Results The VAS scores of the patients in the propacetamol group were lower than those in the control group at 6-12 h and >12-24 h after surgery ( P <0.05).There was no significant difference in VAS score between the two groups ( P >0.05).The total number of remedial analgesics used in the total amount of 0-24 h and postoperative period >12-24 h was less than that of the control group,and the difference was statistically significant ( P <0.05).The dose of fentanyl as a remedy for analgesia was lower than that of the control group,and the difference was statistically significant ( P <0.05).The total amount of morphine converted from remedial analgesic drugs was lower than that of the control group at 0-24 hours after surgery,6-12 hours after operation,and >12-24 hours after operation.The difference was statistically significant ( P <0.05).The total number of cases of nausea occurred in the propidium hydrochloride group from 0-24 hours after operation was lower than that in the control group,the difference was statistically significant ( P <0.05);the degree of postoperative nausea and the use of remedial analgesics in the two groups There was no significant difference in the number comparison ( P >0.05).There was no significant difference in the total consumption of PCA and the amount of morphine converted between the two grou

关 键 词：盐酸丙帕他莫 芬太尼 患者自控镇痛 术后疼痛 术后恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]