尹芳++++++刘爱华++++++田利川++++++张会敏

[摘要] 目的 分析酮咯酸氨丁三醇聯合喷他佐辛用于全身麻醉术后的镇痛疗效。 方法 选取2015年2月～2016年2月在沧州市人民医院拟行全身麻醉下开腹手术患者200例作为研究对象，按照随机数字表法分为试验组和对照组，每组各100例。手术结束后两组患者均使用静脉自控镇痛。试验组在术前30 min肌注酮咯酸氨丁三醇60 mg，对照组用等量生理盐水代替。观察2组术后1、2、4、6、8、12、24 h疼痛程度（VAS评分）、镇静程度（Ramsay评分）以及各时刻平均脉压（MAP）、心率（HR）、血氧饱和度（SpO2），对术后24 h PCIA泵平均按压次数和药物用量，并比较两组不良反应发生率。 结果 两组术后1、2、4、6、8 h VAS评分逐渐显著降低（P < 0.05），且试验组显著低于对照组（P < 0.05），术后12、24 h VAS评分比较差异无统计学意义（P > 0.05）；两组术后1、2、4、6、24 h Ramsay评分比较差异无统计学意义（P > 0.05），试验组术后8、12 h Ramsay评分显著高于对照组（P < 0.05）；试验组术后24 h PCIA泵平均按压次数和药物用量显著低于对照组（P < 0.05）；试验组术后2、4 h MAP、HR显著高于术后1 h（P < 0.05），对照组术后2、4、6、8 h MAP、HR显著高于术后1 h（P < 0.05），试验组6、8 h MAP、HR显著高于对照组（P < 0.05），两组术后12、24 h MAP、HR比较差异无统计学意义（P > 0.05）。 结论 酮咯酸氨丁三醇联合喷他佐辛可有效减轻全身麻醉患者术后疼痛，不良反应少，安全性高。

[关键词] 酮咯酸氨丁三醇；喷他佐辛；镇痛；全身麻醉

[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0063-04

Analgesic effect of Ketorolac Tromethamin combined with Pentazocine after general anesthesia

YIN Fang LIU Aihua TIAN Lichuan ZHANG Huimin

Department of Anesthesiology， People's Hospital of Cangzhou City， Hebei Province， Cangzhou 061000， China

[Abstract] Objective To analyze analgesic effect of Ketorolac Tromethamin combined with Pentazocine after general anesthesia. Methods From February 2015 to February 2016， in Cangzhou People's Hospital， 200 patients treated with open surgery under general anesthesia in were selected， and they were divided into experiment group and control group according to the random number table method， 100 cases in each group. Patients in two groups were given PCIA after surgery， the experiment group was given Ketorolac Tromethamin 60 mg intramuscular at 30 min before surgery， control group was given equivalent normal saline. The degree of pain （VAS）， the degree of sedation （Ramsay score） and the average pulse pressure （MAP）， HR， SpO2 after operation of 1， 2， 4， 6， 8， 12， 24 h were observed， and PCIA pressing times and drug dosage after surgery 24 h were analyzed， and adverse reaction rates in the two groups were compared. Results VAS scores of two groups gradually decreased significantly at postoperative 1， 2， 4， 6， 8 h， and VAS scores of the experiment group were significantly lower than those in the control group （P < 0.05）， and there were no statistically significant differences at postoperative 12， 24 h between the two groups （P > 0.05）. There were no significant differences in Ramsay scores at postoperative 1， 2， 4， 6， 24 h between the two groups （P > 0.05）， Ramsay scores at postoperative 8， 12 h in the experiment group were significantly higher than those in the control group （P < 0.05）. PCIA pressing times and the dosage at postoperative 24 h in the experiment group were significantly lower than those in the control group （P < 0.05）. MAP， HR at postoperative 2， 4 h in the experiment group were significantly higher than those at postoperative 1 h （P < 0.05）， and MAP， HR at postoperative 2， 4， 6， 8 h in the control group were significantly higher than those at postoperative 1 h （P < 0.05）. MAP， HR at postoperative 6， 8 h in the experiment group were significantly higher than those in the control group （P < 0.05）， and there were no statistically significant differences in SpO2 at postoperative 1， 2， 4， 6， 8， 12， 24 h in the two groups （P > 0.05）. Conclusion Ketorolac Tromethamin combined with Pentazocine can effectively reduce postoperative pain of patients with general anesthesia， with less adverse reactions and high safety.

[Key words] Ketorolac Tromethamin； Pentazocine； Analgesic； General anesthesia

术后镇痛主要目的是减轻患者疼痛，降低应激反应，促进早期康复。目前临床上常用的术后镇痛药物主要为阿片类药物，该类药物具有明显镇痛效果，但恶心、呕吐等不良反应较多[1-2]。喷他佐辛在临床广泛用于术后镇痛，其作为吗啡烷类衍生物，对于各种原因引起的疼痛具有良好作用，且术后不良反应低于芬太尼[3]。酮咯酸氨丁三醇属于非甾体类抗炎药，可通过抑制外周敏感化从而发挥镇痛作用[4]，但单独使用酮咯酸氨丁三醇超前镇痛或术后给予喷他佐辛使用剂量较大，可增加术后不良反应。因……