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目的 比较术前预用恩再适对不同剂量芬太尼用于子宫全切术后患者自控静脉镇痛的影响.方法 选择全麻下子宫全切术的患者120例,术后采用芬太尼经生理盐水稀释后行患者自控静脉镇痛(PCIA),并根据不同的用药方法随机分为四组:A组,芬太尼1 mg+0.9%NaCl共100 ml;B组,芬太尼0.5 mg+0.9%NaCl共100 ml;C组,术前晚、麻醉前、术毕各经静脉注射恩再适3.6 U,芬太尼0.7 mg+0.9%NaCl共100 ml;D组,术前晚、麻醉前、术毕各经静脉注射恩再适7.2 U,芬太尼0.5 mg+0.9%NaCl共100 ml,每组30例.术后24 h内采用视觉模拟评分(VAS)、PCA按压次数来观察各组镇痛效应及恶心呕吐、嗜睡等不良反应的发生率.结果 B组术后2 h时的VAS评分显著高于A、C和D组(P<0.05),而2 h后的VAS四组间差异无统计学意义(P>0.05).24 h内的PCA按压次数B组显著多于A、C和D组(P<0.05).B、C和D组中恶心、呕吐、皮肤瘙痒及嗜睡等不良反应的发生率显著低于A组(P<0.05).镇痛期间无呼吸抑制、异常出血等严重并发症的发生.结论 术前预用恩再适复合小剂量芬太尼用于子宫全切术后静脉镇痛可取得满意的镇痛效果,并能减少芬太尼的用量及不良反应的发生率.

Objective To compare the effect of preoperative intravenous injection of Analgecine on the analgesic efficacy and complications of patient-controlled intravenous analgesia(PCA) of different doses of fenta- nyl in postoperative total hysterectomy patients. Methods 120 patients undergoing total hysterectomy in general anesthesia were randomly divided into four groups with thirty cases each. Fentanyl 1 mg in group A ,fentanyl 0.5 mg in group B,fentanyl 0. 7 mg in group C,fentanyl 0. 5 mg in group D. The drugs in each group were diluted to 100 ml and infused by pumps. Besides,the patients in group C and D were injected with Anaigecine 3.6 U and 7. 2 U at the night before the operation, preoperation and postoperation respectively. The visual analog scale (VAS) ,times of PCA and incidence of side effects were recorded during the period of postoperative 24 hours. Results The VAS of group B at 2 h after operation was significantly higher than that of group A, C and D (P < 0.05) ,which became similar 2 h later(P > 0. 05). The demanding times for supplemental bolus in group B was also significantly higher than that of A, C and D (P < 0. 05). The incidence of nausea, vomiting, itching, somno- lence in group B, C and D were significantly less than those in group A (P < 0.05). No respiratory depression or abnormal bleeding occurred in four groups. Conclusion Preoperative intravenous injection of Analgecine has a better effect on patient-controlled intravenous analgesia(PCIA) of fentanyl and can reduce fentanyl requirement and its side effects in total hysterectomy patients.