开胸术后皮下注射芬太尼镇痛效果的研究

INTRADERMAL FENTANYL ANALGESIA AFTER THORACIC SURGERY

摘要:

目的:观察不同剂量芬太尼用于开胸术后皮下镇痛的效果和副作用.方法:将40例行普胸手术的患者随机分为两组,A组芬太尼0.006 mg.kg-1.d-1,B组芬太尼 0.008 mg.kg-1.d-1,两组均加入氟哌利多0.05 mg.kg-1.d-1,2%利多卡因10ml,用生理盐水稀释至100 ml,采用一次性止痛装置(总量100ml ,2ml/h),于上臂皮下持续输注.术后6h、10h、20h、28h、48h记录MAP、HR、SpO2、RR、疼痛评分(VAS)、镇静评分、咳嗽评分、并发症、病人和病房医生对镇痛总体质量满意度.结果: B组疼痛评分明显低于A组(P<0.05),镇静评分及咳嗽评分明显高于 A组(P<0.05).B组有两例病人因嗜睡、不能排痰而造成呼吸道梗阻,1例肺不张.病人对A组镇痛效果不满意(P<0.05),外科医生对两组均不满意.结论: 开胸术后采用皮下镇痛的方法虽能达到良好的镇痛效果,但由于并发症的发生应慎用.

Abstract:

Objective: To observe the effects and safety of intradermal fentanyl analgesia for the patients following thoracic surgery. Methods: 40 patients undergoing general thoracic surgery were randomly divided into tow groups. Group A received intradermal fentanyl 0.006mgkg~(-1)d~(-1), and group B 0.008mgkg~(-1)d~(-1), combined with droperidol 5mg and 2% lidocaine 10ml in 100ml of saline. Fentanyl was delivered by analgesia pump with capacity 100ml and constant delivery rate 2ml/h. The MAP, HR, SpO_2, RR, VAS, scale of sedation, scale of cough, complications, patients and doctors' satisfaction about analgesic effect had been recorded at 6h, 10h, 20h, 28h, 48h after operation. Results:The VAS in group B was significantly lower than that in group A (P<0.05). The scale of sedation and cough in group B were significantly higher than in group A (P<0.05). Two patients had air way obstruction in group B due to drowsiness and expectoration asthenia, and one had atelectasis. The patients in group A were less satisfied with analgesia than group B (P<0.05). The surgeons were not satisfied with both groups. Conclusion: For patients following thoracis surgery, intradermal injection with fentanyl should be carefally used because of its complications, although it is enough to relieve pain.