王锦春+刘玉+张先霞

[摘要]目的：观察舒芬太尼复合纳布啡用于假体隆乳术后镇痛镇静效果和不良反应。方法：选择择期行假体隆乳整形术就医者90例，均采用全身麻醉，术后行静脉自控镇痛。根据静脉自控镇痛药物配比不同，分为纳布啡组（N组）、舒芬太尼组（S组）和舒芬太尼+纳布啡组（SN组）三组，每组30例。观察就医者术后2h、6h、12h、24h时的生命体征，比较各时间点就医者疼痛视觉模拟评分法（VAS）评分、Ramsay镇静评分、自控镇痛次数、镇痛效果及不良反应发生率。结果：N组各时间点VAS评分明显高于S组和SN组，差异有统计学意义（P<0.05）；SN组各时间点的Ramsay评分明显高于N组和S组，差异有统计学意义（P<0.05）；N组各时间点药物用量，按压次数均高于S组、SN组，差异有统计学意义（P<0.05）；S组与N组、SN组比较，恶心、呕吐、头晕等不良反应发生率明显升高，差异有统计学意义（P<0.05）。结论：舒芬太尼复合纳布啡用于假体隆乳术后静脉自控镇痛，可提供较好的镇痛镇静效果，不良反应发生率低，值得临床推广。

[关键词]假体隆乳术；舒芬太尼；纳布啡；静脉自控镇痛

[中图分类号]R655.8 R971+.2 [文献标志码]A [文章编号]1008-6455（2017）10-0050-03

Abstract： Objective To observe the effect of sufentanil and nalbuphine for sedation， analgesia and adverse reaction after mammoplasty augmentation. Methods 90 patients undergoing elective breast augmentation and plastic surgery were treated with general anesthesia and postoperative patient-controlled intravenous analgesia. Randomly divided into nalbuphine group（N group）， sufentanil group（S group） and sufentanil + nalbuphine group（SN group）， 30 cases in each group. The vital signs of 2h， 6h， 12h， 24h after operation were observed， and the incidence of pain， visual analogue scale， VAS score， Ramsay sedation score， number of controlled analgesia， analgesic effect and adverse reaction were compared at various points of time. Results VAS score at each time point of N group was significantly higher than that of group S and group SN， the difference was statistically significant（P<0.05）. The Ramsay score at each time point of SN group was significantly higher than that of group N and group S， the difference was statistically significant（P<0.05）. N group at each time point， the amount of medication， the number of pressing were higher than those in group S and group SN， the difference was statistically significant（P<0.05）. Compared with group N and group S， the incidence of adverse reactions such as nausea， vomiting and dizziness in group SN was significantly higher than that in group B， and the difference was statistically significant（P<0.05）. Conclusion Sufentanil and nalbuphine for mammoplasty augmentation postoperative analgesia， sedation and analgesia can provide better effect， low incidence of adverse reactions， it is worthy of clinical promotion.

Key words： mammoplasty augmentation； sufentanil； nalbuphine； patient controlled intravenous analgesia

整形美容就醫者不是一般意义上的病患，他们追求变美的同时，不仅关心手术的安全性和有效性，更注重全过程的无痛体验。但假体隆乳术后疼痛十分剧烈，给就医者身体和心理上带来非常不好的体验。所以，完善的术后镇痛操作不仅可减轻就医者痛苦，还可减少术后并发症的发生，从而有助于就医者快速恢复。静脉自控镇痛（PCIA）是目前临床术后镇痛的常用方法。纳布啡是阿片受体激动-拮抗药，作用于k受体发挥其镇痛和镇静效应[1]。舒芬太尼是一种阿片受体激动剂，具有较强的镇痛和镇静效果。但舒芬太尼可以引起多种副作用，包括恶心、呕吐、呼吸抑制、瘙痒、尿潴留等。本研究将舒芬太尼复合纳布啡应用于假体隆乳术后镇痛，观察其效果。endprint

1 资料和方法

1.1 一般资料：选择择期在全麻下行假体隆乳手术就医者90例，均采用腋窝下切口双平面隆乳。……