地佐辛对芬太尼术后镇痛半数有效剂量的影响

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1、中图分类号：R614；R971+.2；R619硕士学位论文地佐辛对芬太尼术后镇痛半数有效剂量的影响院（系）、所临床医学院研究生姓名周攀科学科、专业麻醉学导师姓名兰志勋主任医师二Ο一二年四月目录1地佐辛对芬太尼术后镇痛半数有效剂量的影响„„„„„11.1中文摘要„„„„„„„„„„„„„„„„„„„„„11.2英文摘要„„„„„„„„„„„„„„„„„„„„„31.3前言„„„„„„„„„„„„„„„„„„„„„„„61.4材料与方法„„„„„„„„„„„„„„„„„„„„91.5结果„„„„„„„„„„„„„„„„„„„„„„„161.6讨论„„„„„„„„„„„„„„„„„„„

2、„„„„251.7结论„„„„„„„„„„„„„„„„„„„„„„„331.8参考文献„„„„„„„„„„„„„„„„„„„„„341.9英汉缩略词对照表„„„„„„„„„„„„„„„„„382致谢„„„„„„„„„„„„„„„„„„„„„„„393地佐辛用于术后镇痛的研究进展（综述）„„„„„„„„„„„„„„„„„„„„„„„„„40地佐辛对芬太尼术后镇痛半数有效剂量的影响摘要目的：评估地佐辛对芬太尼在术后镇痛中半数有效剂量的影响。方法：选取拟于在全身麻醉下择期行四肢的骨科手术患者，ASA分级为Ⅰ2或Ⅱ级，体重指数为18～25kg/m，年龄18～65岁，采用根据患者入选顺序，

3、将其随机分为4组，序贯法给予术后镇痛，主要镇痛方案：地佐辛+芬太尼。D0组未给予地佐辛，D1组加入地佐辛0.1mg/kg，D2组加入地佐辛0.2mg/kg，D3组加入地佐辛0.3mg/kg。D0组第1例患者芬太尼剂量为16ug/kg，以VAS评分≤3分为镇痛成功，确定下一例患者的芬太尼剂量，相邻剂量梯度为1ug/kg。D1组芬太尼的起始剂量根据D0组芬太尼的ED50来确定。最后算出各个剂量组的芬太尼用于术后静脉镇痛的ED50及其95%可信区间（95%CI）。结果：1、将四个剂量组病例的性别、年龄、体重指数、手术时间进行比较，没有统计学差异（P>0.05）。2、四组患者各时点生命体

4、征（HR、RR、BP、SPO2）：（1）组间对比：①四个剂量组各个时间点的HR、RR及SPO2进行组间比较，没有统计学差异（P>0.05）。②SBP:与D0组相比,D2组在术后4h、12h、24h及48h均低于D0组,(p<0.05);D3组在术后4h低于D0组,(p<0.05)。与D1组相比，D2组在术后12h、24h及48h均低于D1组,(p<0.05)。③DBP：与D0组相比,D2组在术后4h、24h及48h均低于D0组,(p<0.05);D3组在术后4h、12h低于D0组,(p<0.05)。与D1组相比，D2组在术后48h低于D1组,(p<0.05)。（2）组内比较：①四

5、组患者术后各时点HR、RR及SPO2同麻醉前相比较，无统计学差异（P>0.05）。②SBP:D0组在术后12h、24h及48h收缩压较麻醉前降低,差异有统计学意义，(P<0.05);D2组与D3组在术后4h、12h、24h及48h收缩压较麻醉前降低,差异有显著统计学意义，(P<0.01)。③DBP:D1组在术后24h舒张压较麻醉前降低，(P<0.05);D2组与D3组在术后4h、12h、24h及48h舒张压较麻醉前降低,差异有统计学意义，(P<0.05)。3、四组患者芬太尼术后镇痛剂量的比较：①D1、D2、D3组芬太尼的用量明显大于D0组，差异有统计学意义（p<0.01）。②D1

6、组芬太尼的用量亦明显大于D2、D3组，差异有统计学意义（p<0.01）。③D2、D3组之间芬太尼的用量无显著差异（P>0.05）。4、四组患者芬太尼术后镇痛的ED50及95%CI：D0组、D1组、D2组和D3组芬太尼术后镇痛的ED50分别为11.91ug/kg（95%CI11.51～12.33ug/kg）、16.60ug/kg（95%CI15.21～18.11ug/kg）、14.79ug/kg（95%CI13.52～16.18ug/kg）、13.77ug/kg（95%CI13.52～14.03ug/kg）结论：小剂量(0.1~0.3mg/kg)的地佐辛与芬太尼混合用于术后镇痛，表

7、现为拮抗作用，不建议将小剂量的地佐辛与芬太尼混合用于术后静脉镇痛。关键词：地佐辛；芬太尼；剂量效应关系，药物；EffectofDezocineonmedianeffectivedoseofFentanylinpostoperativeanalgesiaAbstract：Objective:Toexploretheeffectofdezocineonmedianeffectivedose(ED50)offentanylinpatientsforpostoperativepain.M