【摘要】 目的探讨双氯芬酸钠栓剂(DSS)联合布托啡诺静脉术后镇痛的效果。方法 50例老年腹部手术患者随机均分为两组,均行布托啡诺静脉自控镇痛(PCIA):布托啡诺+托烷司琼10mg+生理盐水配至100ml。Ⅰ组用布托啡诺12mg;Ⅱ组用布托啡诺6mg,并于术毕即刻将DSS100mg轻轻塞入肛门内2cm。记录术后48h内的视觉模拟评分(VAS)、Ramsay镇静评分、布托啡诺用药总量和不良反应。结果两组术后镇痛、镇静效果均满意。术后6-36h各时点Ⅰ组Ramsay镇静评分明显高于Ⅱ组(P<0.05)。Ⅰ组48h内布托啡诺用药总量为(10.6±0.8)mg,明显多于Ⅱ组的(5.5±0.4)mg(P<0.01);Ⅰ组术后12和24h两个时点SpO2明显低于Ⅱ组(P<0.05),且Ⅰ组头晕、嗜睡、恶心呕吐不良反应病例明显多于Ⅱ组(P<0.05)。结论与单纯大剂量布托啡诺PCIA比较,DSS联合小剂量布托啡诺PCIA,能获得相似镇痛效果,减少布托啡诺不良反应。更多还原

【Abstract】 Objective To evaluate the outcomes of diclophenac sodium suppositories(DSS) combined with butorphanol patient-controlled intravenous analgesia(PCIA) in the elderly after abdominal surgery. Methods Fifty patients were equally randomized into two groups of Ⅰ(PCIA with butorphanol 12mg) and Ⅱ(PCIA with butorphanol 6mg plus DSS inserted to the anus).The PCIA solution consisted of butorphanol,ropisetron 10mg and normal saline 100ml.VAS pain score and Ramsay sedation score were recorded at 6,12,24,36 and 48h after operation.Butorphanol consumption in 48h was calculated and adverse responses were recorded. Results The efficacy of analgesia and sedation in both groups was satisfactory. Sedation at 6-36h was better in group Ⅰ than that in group Ⅱ(P<0.05).Butorphano 48-h consumption in group Ⅱ was significantly less than that in group Ⅰ[(5.5±0.4)mg vs.(10.6±0.8)mg](P<0.01).The values of SpO2 at 12h and 24h were lower in group Ⅰ than those in group Ⅱ(P<0.05).The cases of dizziness,lethargy,nausea and vomiting in group Ⅰ were significantly more than those in group Ⅱ(P<0.05). ConclusionCompared to PCIA with large dose of butorphanol,the same satisfactory analgesia can be obtained by small dose of butorphanol combined with DSS in elderly patients after abdominal surgery with less adverse responses induced by butorphanol.更多还原