【摘要】 目的探讨丁丙诺啡联合地佐辛皮下患者自控镇痛(PCA)的术后镇痛效果。方法择期手术患者643例实施皮下PCA。镇痛药:S组(153例)为丁丙诺啡(0.034~0.036)mg/kg+0.75%左旋布比卡因20ml+雷莫司琼0.6mg,用0.9%氯化钠稀释至150ml;P组(490例)在上述配方中增加地佐辛10mg。于术后1、24、48和72h采用痛觉数字评价量表(NRS)评分和镇静程度(LOS)评分评估镇痛、镇静效果,记录相关不良反应发生情况。结果两组患者静息和活动状态下的NRS评分相仿,镇痛效果满意(P>0.05)。P组术后24h的LOS评分低于S组(P<0.01)。P组丁丙诺啡用量少于S组[(0.027±0.007)mg/kg vs.(0.034±0.013)mg/kg](P<0.01)。S组镇痛泵夹管、恶心、呕吐、皮肤瘙痒及嗜睡发生率高于P组(P<0.05)。结论丁丙诺啡联合地佐辛皮下PCA镇痛效果满意,加用地佐辛可减少丁丙诺啡用量及其相关不良反应。更多还原

【Abstract】 Objective To observe the efficacy of subcutaneous patient-controlled analgesia(PCA)with buprenorphine combined with dezocine.Methods Subcutaneous PCA was performed in643 patients after elective surgeries.The analgesic solution in group S(153cases)consisted of buprenorphine 0.034~0.036mg/kg,0.75%levobupivacaine 20 ml and ramosetron 0.6mg,which was diluted with normal saline up to 150 ml.Dezocine 10 mg in group P(490cases)was added into the analgesic solution of group S.The outcomes of analgesia and sedation were evaluated with numeric rating scale(NRS)and level of sedation(LOS)scoring at 1,24,48 and 72hours during PCA.The analgesia-related adverse effects were recorded.Results The analgesia of both groups was all satisfactory and there was no significant difference in NRS scores at rest and active status between groups of P and S(P>0.05).The LOS score at 24 hours was significantly lower in group P than that in group S(P<0.01).The consumption of buprenorphine was significantly less in group P than that in group S[(0.027±0.007)mg/kg vs.(0.034±0.013)mg/kg](P<0.01).The incidences of clamping analgesic tube,nausea,vomiting,skin pruritus and drowsiness were significantly lower in group P than those in group S(P<0.05).Conclusion Subcutaneous PCA with buprenorphine combined with dezocine can provide a satisfactory analgesia with reduced consumption of buprenorphine and its adverse effects.更多还原