摘要
目的:探讨区域神经阻滞联合阿片类药物多模式镇痛用于口腔颌面肿瘤根治及股前外侧皮瓣修复术后患者镇痛的有效性和安全性。方法:将择期行口腔颌面肿瘤根治股前外侧皮瓣修复患者60例随机分为实验组和对照组,每组各30例。实验组在术毕前30 min,于B超引导下行术侧股神经联合股外侧皮神经阻滞,分别注入0.25%左旋布比卡因15 mL,同时接PCIA泵(舒芬太尼1.5μg/kg+地佐辛0.1 mg/kg+雷琼0.4 mg/0.9%NS 100 mL)。对照组于术毕前30 min接PCIA泵(舒芬太尼2μg/kg+地佐辛0.2 mg/kg+雷琼0.6 mg/0.9%NS 100 mL)。分别记录2组患者的一般情况,观察术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)时的镇静镇痛评分,比较2组不良反应的发生率。采用SPSS19.0软件包进行数据分析。结果:在T1、T3、T4时,2组患者VAS和Ramsay评分无统计学差异(P>0.05);在T2时,实验组的VAS评分大于对照组,差异有统计学意义(P<0.05);实验组的不良反应率为10.0%,显著低于对照组的36.6%(P<0.05)。结论:区域神经阻滞联合阿片类药物静脉镇痛用于口腔颌面肿瘤根治及股前外侧皮瓣修复术后镇痛的效果确切,且可减少阿片类药物不良反应的发生率。
PURPOSE: To investigate the efficacy and safety of regional analgesia combined with opioid analgesia in patients with radical resection of oral and maxillofacial tumors and reconstruction with anterolateral thigh flap.METHODS: Sixty patients with oral and maxillofacial tumors were randomly divided into experimental group and control group. In the experimental group, ultrasound guided femoral nerve block combined with lateral femoral cutaneous nerve block were performed 30 minutes before operation ending, and 0.25% levobupivacaine(15 mL) was injected into the operation side, while PCIA was connected(sufentanil 1.5 μg/kg+ dezocine 0.1 mg/kg+ ramosetron 0.4 mg/0.9%NS 100 mL).Patients in the control group received PCIA 30 min before operation ending(sufentanil 2 μg/kg + dezocine 0.2 mg/kg +ramosetron 0.6 mg/0.9%NS 100 mL). The general conditions, VAS and Ramsay scores at 6 h(T1),12 h(T2), 24 h(T3), 48 h(T4) after operation were observed, and the incidence of adverse reactions was recorded. The data were analyzed using SPSS 19.0 software package. RESULTS: There was no significant difference in VAS and Ramsay scores between the two groups at T1, T3, T4(P>0.05). At T2, the VAS score of the experimental group was significantly higher than that of the control group(P<0.05). The adverse reaction rate of the experimental group was 10%, which was significantly lower than36.6% in the control group(P<0.05). CONCLUSIONS: Regional analgesia combined with opioid analgesia for patients with radical resection of oral and maxillofacial tumors and reconstruction with anterolateral thigh flap had a definite effect and could reduce the opioid adverse reactions.
作者
辛志祥
陶智蔚
郑永超
吕翔
XIN Zhi-xiang;TAO Zhi-wei;ZHENG Yong-chao;LV Xiang(Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai 200011, China)
出处
《中国口腔颌面外科杂志》
CAS
2019年第2期159-162,共4页
China Journal of Oral and Maxillofacial Surgery
关键词
口腔颌面肿瘤
股前外侧皮瓣
股神经阻滞
股外侧皮神经阻滞
舒芬太尼
地佐辛
镇痛
Oral and maxillofacial tumor
Anterolateral thigh flap
Femoral nerve block
Lateral femoral cutaneous nerve block
Sufentanil
Dezocine
Analgesia
