舒芬太尼联合地佐辛用于老年患者下肢关节置换术后静脉镇痛的临床观察

目的观察老年患者下肢关节置换手术后舒芬太尼联合地佐辛静脉镇痛（PatientIntravenousAnalgesia，PIA）的疗效与安全性。方法选择2012年10月-2013年4月在该院择期行膝髋关节置换术的老年患者（年龄≥65岁），60例ASAII～Ⅲ级，依据镇痛泵配方随机分为3组：I组（舒芬太尼组）；Ⅱ组（舒芬太尼＋地佐辛组）；III组（舒芬太尼＋地佐辛肌注组）。各组PIA泵的背景输注量2mL／h，视觉模拟评分（VisualAnalogueScale，VAS）〉5肌注杜冷丁50mg。观察各组术后6h、12h、24hVSA评分、Ramsay评分、不良反应发生率及术后额外镇痛药用量。结果3种配方均能为患者提供良好的术后镇痛。Ⅱ组的VSA评分和不良反应发生率优于I、Ⅲ组，Ⅲ组术后6hRamsay评分明显高于I组和Ⅱ组（P〈0．05），术后需额外镇痛的病人数也明显多于其它两组（P〈0．05）。结论舒芬太尼联合地佐辛用于老年患者膝髋关节置换术后镇痛可提高术后镇痛质量，减少阿片类药物的用量，减少术后不良反应的发生率，值得临床应用。

The Effects of Postoperative Intravenous Analgesia with Dezocine and Sufentanil on Elderly Patients after Arthroplasty

Objective To evaluate the effects and safety of intravenous analgesia with dezocine combining sufentanil on hip and kfiee arthroplasty for elderly patients. Methods 60 patients aged 65 or older with ASA II - III, who were scheduled for hip and knee arthroplasty under CSEA and treated with postoperative intravenous analgesia in our hospital from October, 2012 to April, 2013 were divided into 3 groups according to analgesia pump formulation： group I （sufentanil group）, group II （sufentanil and de zocine group） and group III（intramuscular sufentanil and dezocine group）. Each group＇s PIA pump background infusion was 2 mL / h, and 50rag meperidine was administered intramuscularly as rescue medication when VAS was above 5. VSA, Ramsay scores, side effects as well as postoperative additional analgesics dosage were recorded at 6 h, 12 h and 24 h after operation. Results All the three formulations had good postoperative analgesic effect. The VSA scores and incidence of side effects of group II were better than those of group I and group m. 6h after the operation, the Ramsay scores of group III were significantly higher than those of group I and group II （P〈0.05）, and the patients needed additional analgesia were obviously more than those of the other two groups （P〈0.05）. Conclusion For elderly patients underwent knee and hip arthroplasty, sufentanil combined with dezocine can improve the effect of postoperative analgesia, reduce opioid dosage and the incidence of postoperative side effects, which is worthy of clini- cal application.