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地佐辛与芬太尼在鼾症患者术后静脉镇痛的评价

孙成亮1,吕国义2,邓廼封2,李波3   

  1. 1. 天津市天津医科大学第二医院
    2. 天津医科大学第二医院麻醉科
    3. 天津医科大学第二医院
  • 收稿日期:2011-05-16 修回日期:2011-07-01 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 吕国义

The Evaluation of Postoperative Analgesia with Dezocine and Fentanyl in Patients with Obstructive Sleep Apnea Syndrome

  • Received:2011-05-16 Revised:2011-07-01 Published:2012-09-15 Online:2012-09-15
  • Contact: Guo-Yi LV

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摘要： 摘要 目的: 探讨地佐辛与芬太尼用于悬雍垂-腭-咽成形术(UPPP)的患者行静脉自控镇痛(PCIA)的有效性及安全性。方法: 40例择期行UPPP的阻塞性睡眠呼吸暂停综合征(OSAS，即鼾症)患者，ASAⅠ~Ⅱ级，随机分为2组(n=20)，F组：芬太尼16μg／kg；D组：地佐辛0.8mg／kg，两组镇吐药均为5mg氟哌利多，以生理盐水稀释至100 ml，背景剂量2ml／h，PCIA 1.0ml／次，锁定时间15min。观察术后1、3、6、12、24h时疼痛视觉模拟评分(VAS)、Ramesay镇静评分、PCIA按压次数、呼吸和循环的变化及不良反应。结果: 两组患者均镇痛良好。VAS值和Ramsay评分方面，F组在术后1h镇痛效果好于D组，但存在镇静过度（P < 0.05），其余时间点两组差异无统计学意义（P > 0.05）。两组患者PCIA按压次数差异无统计学意义（P > 0.05）。呼吸、循环方面，F组MBP、HR在术后1~3h低于D组(P < 0.01或0.05)，SPO2在术后1h低于D组(P < 0.01)。不良反应方面，F组恶心呕吐及呼吸抑制的发生率高于D组(P < 0.05)，其余不良反应两组差异无统计学意义(P > 0.05)。结论: 与芬太尼相比，地佐辛应用于鼾症患者术后静脉自控镇痛对呼吸、循环影响小，更为安全。

关键词: 地佐辛, 芬太尼, 静脉自控镇痛, 阻塞性睡眠呼吸暂停综合征, 悬雍垂-腭-咽成形术

Abstract: Abstract Objective：To evaluate the analgesic efficiency and safety of patient-controlled analgesia (PCIA) effects with dezocine and fentanyl following uvulopalatopharyngiplasty (UPPP) surgery. Methods: Forty ASA I～Ⅱpatients undergoing UPPP surgery were randomly divided into two groups equally with 20 cases each: group F (fentanyl 16μg／kg) and group D (dezocine 0.8mg/kg). The drugs including 5mg of droperidol were diluted with normal saline to 100 ml and were given via PCIA after surgery. The PCIA rate was 2 ml／h, bolus 1.0 mL, lockout time 15 min. Postoperative analgesia efficiency was assessed by Visual Analogue Scale (VAS) and Ramsay score at 1, 3, 6, 12, 24h. The circulatory, ventilatory function , PCIA pressing times and side effects were also recorded. Results：The patients in both groups showed good pain relief. In group F, VAS scores were lower while Ramsay scores were higher than those of group D at 1h (P < 0.05). There were no significant differences in VAS and Ramsay scores in the two groups at the other time (P > 0.05). In the two groups, there were no significant differences in PCIA pressing times (P > 0.05). In group F, MAP and HR were lower than those of group D at 1-3 h (P < 0.01或0.05). In group F, SPO2 were lower than that of group D at 1h (P < 0.01). In group F, the nausea and vomiting and the respiratory depression were higher than those of group D (P < 0.05). There were no significant differences in other side effects in the two groups (P > 0.05). Conclusion: Comparing with fenatanyl, postoperative patient-controlled intravenous analgesia with dezocine may be the preferred analgesic following UPPP surgery.

Key words: dezocine, fenatanyl, patient-controlled intravenous analgesia, obstructive sleep apnea syndrome, uvulopalatopharyngiplasty