摘要
目的 观察比较芬太尼复合咪唑安定或新斯的明用于术后硬膜外病人自控镇痛 (PCEA)的临床效果。方法 85例 (ASAI Ⅱ级 )在硬膜外麻醉下行妇科手术的病人随机分成三组 ,F组 (n =2 5 ) :用 0 0 0 0 2 %芬太尼 +0 12 5 %布比卡因 ;MF组 (n =30 ) :用F组药液 + 0 0 10 %咪唑安定 ;NF组 (n =30 ) :F组药液 + 0 0 0 2 5 %新斯的明。当病人术后视觉模拟疼痛评分 (VAS) >5时 ,开始镇痛。观察记录注药后 2 4小时内三组病人用药总量 ,PCEA泵使用次数 (按压总数 /实进数 )、VAS、镇静评分、血压、心率、呼吸频率及恶心呕吐、瘙痒、腹胀等并发症。结果 镇痛后2 4小时三组病人PCEA用药量无明显差异 ;VAS评定F组最高 (P <0 0 1) ,PCEA总按压数 /实进数 (A/I)比值在 0～ 2范围内的病人例数 ,MF≈NF >F组 (P <0 0 5 ) ,提示MF、NF组镇痛效果较好 ;镇静评分 :MF组高于NF和F组(P <0 0 1) ;三组病人在PCEA期间血压、心率、呼吸频率均在正常范围 ;三组病人恶心呕吐发生率为 5 %～ 10 % ,腹胀F组 4例、MF组 3例、NF组无一例 ,各组无一例皮肤瘙痒。结论 选择芬太尼和布比卡因行PCEA时 。
Objective: To compare the efficacy of Fentanyl combined with Midazolam or Neostigmine in postoperative patient controlled epidural analgesia. Methods: Eighty five patients(ASA Status ⅠorⅡ) undergoing gynecological procedures under epidural anesthesia were randomly divided into these three groups: group F:0 0002% Fentanyl with 0 125% Bupivacaine; group MF:0 0002% Fentanyl+0 125% Bupivacaine+0 010% Midazolam;group NF:0 0002% Fentanyl +0 125% Bupivacaine+0 0025% Neostigmine for PCEA The postoperative analgesia started when the visual analogue scale (VAS) was higher than 5, and the following data were recorded within 24 hours: the total dose, the number of PCA,VAS,sedation score, heart rate(HR),blood pressure (Bp),respiration rate(RR),SpO 2, nausea and vomitting, pruritus and abdominal distension. Results: The total dose of narcotics did not differ among the three groups. There was a significant lower VAS in groups MF and NF(P<0 01), the number of patients with PCEA attack to injection ratio(A/I ratio) between 0 and 2 were higher in groups MF and NF than that of group F. The sedation scores were the highest in group MF(P<0 01). The incidence of nausea and vomitting was between 5 and 10% in the three groups. The postoperative HR and Bp and RR and SpO 2 were within the normal ranges. Conclusion: Adding low dose Midazolam or Neostigmine to Fentanyl plus Bupivacaine solution for PCEA may greatly enhance the efficacy of postoperative pain relief.
出处
《泰山医学院学报》
CAS
2001年第2期117-119,共3页
Journal of Taishan Medical College
