三种药物对复杂性肛瘘术后镇痛效果的临床观察

目的比较三种药物应用于复杂性肛瘘术患者的镇痛效果及不良反应。方法复杂性肛瘘患者90例,ASAⅠ～Ⅱ级,年龄15～65岁,体质量42～85 kg。随机分为三组：S组：舒芬太尼（100μg）＋左布比卡因（200 mg）;O组：羟考酮（20 mg）＋左布比卡因（200 mg）;M组：氢吗啡酮（2 mg）＋左布比卡因（200 mg）。术后行患者自控的硬膜外镇痛（PCEA）。术后12 h（T1）、24 h（T2）、48 h（T3）对患者进行疼痛视觉模拟评分（VAS）;并询问患者对术后镇痛的满意度;询问并记录相关不良反应如：恶心、呕吐、皮疹瘙痒、体位性头晕、头晕、情绪改变、失眠或嗜睡、尿潴留、口干及其他不良反应。结果在T1及T2时点,与S、O组比较,M组的术后镇痛有效性明显提高（P〈0.05）;T3时点,三组镇痛有效性比较差异无统计学意义（P〉0.05）。三组间各种不良反应比较差异无统计学意义（P〉0.05）。与S、O组比较,M组的满意程度最高,差异有统计学意义（P〈0.05）;与S组比较,O组的满意程度较高,差异有统计学意义（P〈0.05）;三组不满意程度比较差异无统计学意义（P〉0.05）;而可接受程度三组之间比较O组最高,差异有统计学意义（P〈0.05）。结论氢吗啡酮联合左布比卡因适用于肛瘘患者的PCEA,镇痛效果优于舒芬和羟考酮,且不良反应比较差异无统计学意义。

Clinical observation for the analgesic effect of three drugs on complex anal fistula after operation

Objective To compare the analgesia effects and side effects of the three drugs on patients with complex anal fistu- la after operation. Methods Ninety cases of complex anal fistula patients, ASA I - II, aged 15 - 65 years, body weight 42 - 85 kilograms. Patients were randomly divided into three groups： group S： sufentanil （100 ~g） ＋ levobupivacaine （200 mg）; group O ： oxycodone （ 20 mg） ＋ levobupivacaine （ 200 mg） ; group M ： hydromorphone （ 2 mg） ＋ levobupivacaine （ 200 rag） , postop- erative PCEA. The pain visual analogue scale （VAS） and postoperative analgesia satisfaction were observed and recorded at the time point of 12 （ T1 ） , 24 （ T2 ）, 48 hours （ T3 ） after operation ; the related adverse reactions such as nausea, vomiting, rash, pruritus, orthostatic dizziness, dizziness, mood changes, insomnia or hypersomnia, retention of urine, dry mouth, and other ad- verse reaction were recorded. Results At the time point of T1 and T2, compared with group S and group O, the postoperative analgesic effect increased significantly in group M （ P 〈 0.05 ） ; At the time point of T3, the analgesia effectiveness in the three groups had no significant difference （P 〉 0. 05 ）. The various adverse reactions had no significant difference in the three groups （P 〉 0. 05）. Compared with group S and group O, the degree of satisfaction in group M was the highest, the difference was statistically significant （ P 〈 0. 05 ） ; compared with group S, the degree of satisfaction in group O was higher, the difference was statistically significant （ P 〈 0. 05 ） ; the dissatisfaction in the three groups had no significant difference （ P 〉 0. 05 ） ; the acceptable level in group 0 was the highest, the difference was significant （P 〈 0. 05 ）. Conclusion The hydromorphone combined with levobupivacaine is appropriate tbr patients with complex anal fistula after operation in PCEA, the analgesic effect is better than sufentanil and oxycodone, whereas t