舒芬太尼联合地佐辛应用于胰腺肿瘤手术后患者自控静脉镇痛的效果评价  

Efficacy of patient-controlled intravenous analgesia with combination of sufentanil and dezocine in pancreatic tumor patients

作　　者：黄志华[1] 邵海军 陶国荣[1] 陆肖坚 王颖[1] 王嘉怡 张嘉雯 罗艳[1] HUANG Zhihua;SHAO Haijun;TAO Guorong;LU Xiaojian;WANG Ying;WANG Jiayi;ZHANG Jiawen;LUO Yan(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2023年第5期291-296,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(T2293734)。

摘　　要：目的评价舒芬太尼联合地佐辛应用于胰腺肿瘤手术后患者自控静脉镇痛(PCIA)的效果。方法连续性纳入2021年1-12月在上海交通大学医学院附属瑞金医院择期或限期行胰腺肿瘤手术,且术后使用PCIA的793例患者,根据PCIA的镇痛泵配方,将患者分为舒芬太尼组(300例)和舒芬太尼联合地佐辛组(联合地佐辛组,493例)。采用倾向性匹配(PSM)进行1∶1匹配,设定卡钳值为0.02,两组患者匹配成功后每组各257例。分别于术后第1、2、3天记录患者静息时和活动时的疼痛VAS评分情况、中重度疼痛患者比例,以及镇痛相关不良反应(恶心呕吐、皮肤瘙痒、呼吸抑制、头晕)、患者的镇痛满意度、术后追加镇痛药物患者比例。记录患者的手术时间、术中舒芬太尼用量和镇痛泵使用情况(镇痛泵总按压次数、实际给药次数、PCIA舒芬太尼消耗总量)。结果两组间患者性别构成、年龄、BMI、ASA分级构成、基础疾病史、手术部位、手术方式,以及总胆红素、直接胆红素水平的差异均无统计学意义(P值均>0.05)。舒芬太尼组术后第1天静息时疼痛VAS评分为0分的患者比例显著低于联合地佐辛组同时间(P<0.05),≥4分的患者比例显著高于联合地佐辛组同时间(P<0.05);术后第3天静息时和活动时疼痛VAS评分为0分的患者比例均显著低于联合地佐辛组同时间(P值均<0.05),≥4分的患者比例显著高于联合地佐辛组同时间(P值均<0.05)。舒芬太尼组术后第1天静息时的中重度疼痛患者比例,以及术后第3天静息时和活动时的中重度疼痛患者比例均显著高于联合地佐辛组同时间(P值均<0.05)。术后第1、2、3天,两组间患者恶心呕吐、瘙痒、低血压、头晕发生率的差异均无统计学意义(P值均>0.05);术后第3天,联合地佐辛组呼吸抑制发生率显著低于舒芬太尼组(P<0.05)。两组间手术时间、术中舒芬太尼用量、PCIA舒芬太尼消耗总量的差异Objective To evaluate the efficacy of patient-controlled intravenous analgesia(PCIA)with combination of sufentanil and dizocine in pancreatic tumor patients.Methods A total of 793 consecutive patients who underwent pancreatic tumor surgery and received PCIA after surgery at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine between January 2021 and December 2021 were included in this study.According to the formula of PCIA,the patients were divided into sufentanil group(300 cases)and combination group(sufentanil combined with dezocine group,493 cases).A propensity score matching(PSM)was used for 1∶1 matching,with a caliper value of 0.02.After successful matching,257 patients were enrolled in each group.The pain visual analogue scale(VAS)scores at rest and at activity,incidence of moderate to severe pain,analgesia related adverse reactions(nausea,vomiting,itching,respiratory depression,dizziness),patients’satisfaction with pain control,proportion of patients with postoperative additional analgesics on day 1,2 and 3 after surgery were recorded.Operation duration dosage of sufentanil during operation and usage of analgesia pump(total pressing times of PCIA button,actual PCIA administration times,total consumption of sufentanil in PCIA)were also recorded.Results There were no significant differences in the gender,age,body mass index(BMI),American Society of Anesthesiologists(ASA)grading composition,basic disease history,surgical site,surgical method,total bilirubin level or direct bilirubin level between the two groups(all P>0.05).The proportion of patients with pain visual analogue scale(VAS)score of 0 at rest on the first day after operation in the sufentanil group,as well as the proportion of patients with pain VAS score of 0 at rest and at activity on the third day after operation were significantly lower than those in the combination group(all P<0.05).The proportion of patients with pain score≥4 at rest on the first day after operation in the sufentanil group,as well as the propo

关 键 词：倾向性评分匹配 地佐辛 舒芬太尼 患者自控静脉镇痛 胰腺肿瘤 

分 类 号：R614[医药卫生—麻醉学]