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[静脉自控镇痛系统治疗术后疼痛。与吗啡、安乃近和丁丙诺啡的比较]

[Treatment of postoperative pain with intravenous PCA system. Comparison with morphine, metamizole, and buprenorphine].

作者信息

Torres L M, Collado F, Almarcha J M, Huertas V G, de Antonio P, Rodríguez M

机构信息

Servicio de Anestesia y Reanimación, Hospital Universitario Puerta del Mar, Cádiz.

出版信息

Rev Esp Anestesiol Reanim. 1993 Jul-Aug;40(4):181-4.

PMID:8372257
Abstract

OBJECTIVES

To evaluate the postoperative analgesic efficacy, side effects and acceptance by patients and nurses of intravenous "patient-controlled analgesia" (PCA) with morphine, metamizole and buprenorphine.

MATERIAL AND METHODS

In this randomized double blind prospective study of 150 patients in three groups receiving morphine (group A), metamizole (group B) or buprenorphine (group C), the patients had undergone low abdominal surgery with the same anesthetic protocol. Pain was recorded during the first 48 h after surgery on an orally-communicated scale of none or slight = 0, moderate = 1 and severe = 2. Upon the first report of moderate pain, patients were administered an intravenous bolus containing 5 mg morphine, 1 g metamizole or 0.15 mg buprenorphine. A perfusion pump was then connected and set with one bolus of 1.2 mg morphine, one of 333 mg metamizole or one of 0.04 buprenorphine. The maximum dose allowed in 24 h was 40 mg morphine, 8 g metamizole or 1.2 mg buprenorphine. The minimum interval between doses was 30 min for all three groups. Side effects reported were respiratory depression, sedation, nausea, vomiting, pruritus, perspiration and pain upon administration. Patients and nurses were asked to evaluate the system when the pump was disconnected and the results were then analyzed statistically.

RESULTS

The analgesic effect was satisfactory in all three groups, with no significant differences among them. The percentages of patients reaching the maximum allowed dose on the first day were 2% with morphine, 18% (p < 0.05) with metamizole and 8% with buprenorphine. No respiratory depression was observed. Sedation was greater with morphine and buprenorphine than with metamizole (p = 0.0001). Pruritus was also greater with morphine and buprenorphine than with metamizole (p = 0.02) and pain upon infusion was greater with metamizole (p = 0.0002).

CONCLUSIONS

Intravenous postoperative PCA was effective with all three drugs studied. Patient and nurse acceptance was good and side effects were few in the three groups. The lower rate of side effects for metamizole makes it the drug of choice.

摘要

目的

评估吗啡、安乃近和丁丙诺啡静脉自控镇痛(PCA)的术后镇痛效果、副作用以及患者和护士的接受程度。

材料与方法

在这项随机双盲前瞻性研究中,150例患者被分为三组,分别接受吗啡(A组)、安乃近(B组)或丁丙诺啡(C组)治疗。所有患者均采用相同的麻醉方案进行下腹部手术。术后48小时内,通过口头交流的方式记录疼痛程度,无痛或轻微疼痛=0,中度疼痛=1,重度疼痛=2。当首次报告中度疼痛时,分别给予患者静脉推注5毫克吗啡、1克安乃近或0.15毫克丁丙诺啡。然后连接灌注泵,并设置为每推注一次1.2毫克吗啡、333毫克安乃近或0.04毫克丁丙诺啡。24小时内允许的最大剂量为40毫克吗啡、8克安乃近或1.2毫克丁丙诺啡。三组的最小给药间隔均为30分钟。记录报告的副作用包括呼吸抑制、镇静、恶心、呕吐、瘙痒、出汗和给药时疼痛。当泵断开连接时,要求患者和护士对该系统进行评估,然后对结果进行统计学分析。

结果

三组的镇痛效果均令人满意,且无显著差异。第一天达到最大允许剂量的患者百分比,吗啡组为2%,安乃近组为18%(p<0.05),丁丙诺啡组为8%。未观察到呼吸抑制。吗啡和丁丙诺啡引起的镇静作用比安乃近更强(p=0.0001)。吗啡和丁丙诺啡引起的瘙痒也比安乃近更严重(p=0.02),而安乃近引起的输液时疼痛更严重(p=0.0002)。

结论

三种研究药物用于术后静脉PCA均有效。三组患者和护士的接受度良好,副作用较少。安乃近的副作用发生率较低,使其成为首选药物。

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