酮咯酸氨丁三醇复合舒芬太尼超前镇痛对腹腔镜子宫切除术后的镇痛作用  

Analgesic effect of preemptive analgesiaon by ketorolac tromethamine combined with sufentanil of the patients after hysterectomy

作　　者：陈伟[1] 胡北[1] 郭淑静[1] 高楝 CHEN Wei;HU Bei;GUO Shujing;GAO Lian(Suqian People's Hospital of Nanjing Gulou Hospital Group,Jiangsu Province,223800)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院,223800

出　　处：《中国计划生育学杂志》2022年第2期327-331,共5页Chinese Journal of Family Planning

基　　金：江苏省南京市卫生和计划生育委员会(YKK16245)。

摘　　要：目的:探讨酮咯酸氨丁三醇复合舒芬太尼用于子宫切除患者术后超前镇痛效果及安全性。方法:选取本院2018年1月-2020年1月择期行腹腔镜子宫切除术患者184例,随机分为观察组(n=92)和对照组(n=92)。两组患者均于手术切皮前30min超前镇痛给药,对照组给予10μg舒芬太尼,观察组给予5μg舒芬太尼+15mg酮咯酸氨丁三醇。术毕均连接自动控制镇痛泵PCIA,对照组使用1μg/kg舒芬太尼,观察组使用3mg/kg酮咯酸氨丁三醇复合1μg/kg舒芬太尼。观察两组患者术毕清醒即刻(T1)、术后2h(T2)、6h(T3)、12h(T4)、24h(T5)及撤PCIA后2h(T6)的视觉模拟评分法(VAS)评分;检测患者手术麻醉前(T0)、T2、T5血清P物质和五羟色胺(5-HT)水平;记录术后镇痛不良反应。结果:VAS评分观察组术后T1(2.95±0.77分)、T2(3.41±0.75分)、T3(3.12±0.79分)时低于对照组(3.33±0.69分、3.86±0.84分、3.45±0.75分)(P<0.05),T4、T5、T6时两组无差异(P>0.05);观察组术后T2、T5、T6时血清P物质、5-HT水平均低于对照组,镇痛不良反应总发生率(5.4%)低于对照组(15.2%)(均P<0.05)。结论:酮咯酸氨丁三醇复合舒芬太尼用于子宫切除超前镇痛,可显著降低患者术后早期血清致痛物质水平,术后镇痛效果好且不良反应发生率低。Objective:To investigate the analgesic effect and safety of preemptive analgesiaon by ketorolac tromethamine combined with sufentanil of the patients after hysterectomy.Methods:184patients who wanted laparoscopic hysterectomy in selected time were randomly divided into experimental group(n=92)and control group(n=92)from January 2018to January 2020.The patients in both groups were given preemptive analgesia at 30min before skin incision,and the patients in the control group were given 10μg sufentanil as preemptive analgesia,while the patients in the experimental group were given 5μg sufentanil combined with 15mg ketorolac tromethamine as preemptive analgesia.After operation,all patients were given controlled intravenously analgesia(PCIA),and the patients in the control group were given 1μg/kg sufentanil,while the patients in the experimental group were given 3mg/kg ketorolac tromethamine combined with 1μg/kg sufentanil.The visual analogue scale(VAS)scores of the patients in the two groups immediately after operation(T1),2hafter operation(T2),6hafter operation(T3),12hafter operation(T4),24hafter operation(T5),and 2hafter PCIA withdrawal(T6)were observed.The levels of serum substance P and serotonin(5-HT)of the patients in the two groups before anesthesia(T0),at T2and T5were detected.The incidences of postoperative analgesic adverse reactions of the patients in the two groups were recorded.Results:VAS scores at T1(2.95±0.77points),T2(3.41±0.75points),T3(3.12±0.79points)of the patients in the experimental group were significantly lower than those(3.33±0.69points,3.86±0.84points,and 3.45±0.75points)of the patients in the control group(P<0.05),but which of the patients at T4,T5and T6had no significant different between the two groups(P>0.05).The levels of serum substance P and 5-HT of the patients in the experimental group at T2,T5,and T6were significantly lower than those of the patients in the control group.The total incidence of adverse analgesia reaction(5.4%)of the patients in the experimental group was

关 键 词：腹腔镜子宫切除手术 超前镇痛 酮咯酸氨丁三醇 舒芬太尼 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]