不同阿片类药物配伍用于胃肠道手术病人术后自控静脉镇痛的效果  

Efficacy of compatibility of different opioids for postoperative patient-controlled intravenous analgesia in patients undergoing gastrointestinal surgery

作　　者：李岩 计根林 穆潇潇 杨璇 林菁菁 Li Yan;Ji Genlin;Mu Xiaoxiao;Yang Xuan;Lin Jingjing(Department of Anesthesia and Perioperative Medicine,Xijing Hospital,Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院麻醉与围术期医学科,西安710032

出　　处：《中华麻醉学杂志》2022年第9期1076-1080,共5页Chinese Journal of Anesthesiology

基　　金：中国初级卫生保健基金会科研基金(YLGX-WS-2020011)。

摘　　要：目的评价不同阿片类药物配伍用于胃肠道手术病人术后自控静脉镇痛的效果。方法回顾性连续收集2018年5月至2022年3月在空军军医大学第一附属医院行胃肠道手术后自控静脉镇痛病人6556例,分为舒芬太尼混合纳布啡组(SN组)、氢吗啡酮混合纳布啡组(HN组)和舒芬太尼组(S组)。SN组、HN组和S组药物配置分别为舒芬太尼100μg+纳布啡40 mg、氢吗啡酮10 mg+纳布啡40 mg、舒芬太尼200μg,稀释至100 ml,背景剂量1 ml/h,PCA剂量0.5 ml,锁定时间10 min。收集3组病人人口学资料、术后24和48 h时静态和动态镇痛不足(VAS评分≥4分的例数)的情况、不良反应发生情况、术后首次排气时间和术后首次下床时间。结果与S组比较,HN组和SN组术后24和48 h时静态和动态镇痛不足发生率、头晕、恶心呕吐发生率、镇痛泵有效按压次数和镇痛泵用药量降低,HN组术后24 h嗜睡发生率降低,首次排气时间和下床时间缩短,SN组术后48 h嗜睡发生率升高(P<0.05);与SN组比较,HN组术后24和48 h时静态镇痛不足发生率升高,动态镇痛不足发生率、头晕、恶心呕吐发生率、镇痛泵有效按压次数和镇痛泵用药量降低,术后24 h嗜睡发生率升高,术后48 h嗜睡发生率降低,首次排气时间和下床时间缩短(P<0.05)。结论氢吗啡酮混合纳布啡用于胃肠道手术病人术后自控静脉镇痛的效果优于舒芬太尼混合纳布啡和舒芬太尼,且氢吗啡酮混合纳布啡有利于缩短胃肠功能恢复时间。Objective To evaluate the efficacy of compatibility of different opioids for postoperative patient-controlled intravenous analgesia(PCIA)in the patients undergoing gastrointestinal surgery.Methods A total of 6556 patients undergoing PCIA after gastrointestinal surgery in the first affiliated Hospital of Air Force military Medical University from May 2018 to March 2022 were retrospectively collected and divided into sufentanil plus nalbuphine group(SN group),hydromorphine plus nalbuphine group(HN group)and sufentanil group(S group).In SN,HN and S groups,the PCIA solutions contained sufentanil 100μg+nalbuphine 40 mg,hydromorphone 10 mg+nalbuphine 40 mg,sufentanil 200μg,respectively,in 100 ml of normal saline,and the PCA pump was set up with a background infusion at a rate of 1 ml/h,bolus dose 0.5 ml,and lockout interval 10 min.The demographic data,the number of patients with insufficient analgesia at rest and during activity(visual analog scale score≥4)at 24 and 48 h after operation,adverse reactions,time to first flatus and first postoperative off-bed time were collected.Results Compared with S group,the incidence of insufficient analgesia at rest and during activity,dizziness,nausea and vomiting,effective pressing times of PCA and consumption of drugs in the analgesic pump were significantly decreased at 24 and 48 h after operation in HN group and SN group,the incidence of drowsiness was decreased at 24 h after operation,and the time to first flatus and first postoperative off-bed time were shortened in HN group,and the incidence of somnolence was increased at 48 h after operation in SN group(P<0.05).Compared with SN group,the incidence of insufficient analgesia at rest at 24 and 48 h after operation was significantly increased,the incidence of insufficient analgesia during activity,dizziness,nausea and vomiting,effective pressing times of PCA and consumption of drugs in the analgesic pump were decreased,the incidence of drowsiness was increased at 24 h after operation,the incidence of somnolence was decrease

关 键 词：镇痛药 阿片类 胃肠道 外科手术 镇痛 病人控制 

分 类 号：R614[医药卫生—麻醉学]