摘要目的 比较芬太尼、曲马多和氟比洛芬酯3种药物在玻璃体切割手术中局部麻醉辅助镇痛的效果.方法 在局部麻醉下行玻璃体切割手术的120例患者纳入研究.采用随机数字表法将患者分为对照组、芬太尼组、曲马多组及氟比洛芬酯组,每组30例.所有患者均给予球后神经阻滞.同时,对照组给予生理盐水10 ml,芬太尼组以1μg/kg的剂量给予芬太尼加生理盐水至10 ml,曲马多组以1 mg/kg的剂量给予曲马多加生理盐水至10 ml,氟比洛芬酯组以1 mg/kg的剂量给予氟比洛芬酯加生理盐水至10 ml.分别于给药前(T0),手术开始时(T1),手术开始后5(T2)、15(T3)、30(T4) min及手术结束时(T5)记录患者平均动脉压(MAP)、心率(HR)、氧饱和度(SpO2)、镇静程度、疼痛程度及镇痛补救发生率,同时对比分析各组不良反应的发生率.结果 芬太尼组MAP在T1、T2时点较T0时点和其他3组T1、T2时点低,差异有统计学意义(F=5.367、5.967,P＜0.05),T3～T5时点逐渐回升；其他3组组内各时点MAP均无明显变化(P＜0.05).对照组HR在T3、T4时点明显低于T0时点,差异有统计学意义(F=7.900、6.767,P＜0.05)；芬太尼组HR在T2时点明显低于T0时点,差异有统计学意义(F=3.117,P＜0.05),T3～T5时点逐渐回升；曲马多组及氟比洛芬酯组组内各时点HR均无明显变化(P＞0.05).芬太尼组SpO2在T1时点较T0时点及其他3组T1时点低,差异有统计学意义(F=7.352,P＜0.05)；其他3组组内各时点SpO2均无明显变化(P＞0.05).芬太尼组镇静程度在T1时点较T0时点及其他3组T1时点低,差异有统计学意义(x2=12.935,P＜0.05)；其他3组组内各时点镇静程度均无明显变化(P＞0.05).对照组疼痛程度评分在T1、T2时点分别为3、2分,均较T0时点及芬太尼组、曲马多组T1、T2时点高,差异有统计学意义(x2=13.748、11.616,P＜0.05)；其他3组组内各时点疼痛程度均无明显变化(P＞0.05).对照组、芬太尼组、曲马多组及氟比洛芬酯组镇痛补救发生率分别为16.7％、3.3％、3.3％、6.7％；不良反应发生率分别为30.0％、23.3％、3.3％、16.7％.结论 曲马多在玻璃体切割手术中局部麻醉辅助镇痛效果确切,且不良反应发生率最低.

abstractsObjective To compare the analgesic effects of fentanyl,tramadol and flurbiprofen axetil during vitrectomy under local anesthesia.Methods One hundred and twenty patients who underwent vitrectomy were randomly divided into four groups,30 patients in each group.Control group (Group C):normal saline were given; Fentanyl group (group F):fentanyl 1 μg/kg; Tramadol group (group T):tramadol 1 mg/kg; Flurbiprofen group (group K):flurbiprofen axetil 1 mg/kg.Mean arterial pressure (MAP),heart rate (HR),oxygen saturation (SpO2),sedation classification (OAA / S) and pain score (NRS) were recorded prior to drug administration (T0) and the beginning of surgery (T1),5 min (T2),15 min (T3),30 min (T4) and the end of surgery (T5).The incidence of analgesic remedy and adverse reactions were also recorded after surgery.Results In group F,MAP at T1 and T2 were significantly lower than T0 and that of the other three groups at the same time point (F=5.367,5.967;P＜0.05).MAP at each time point of the other three groups had no significant changes (P＞0.05).In Group C,HR decreased signiiicantly at T3 and T4 compared to T0 (F=7.900,6.767; P＜0.05).In Group F,HR decreased significantly at T2 compared to T0(F=3.117,P＜0.05).HR at each time point of group T and group K had no significant changes (P＞0.05).In group F,SpO2 at T1 was significantly lower than T0 and that of the other three groups at the same time point (F=7.352,P＜0.05).SpO2 of group F,group T and group K had no significant changes within groups (P＞0.05).In Group F,the median of OAA / S classification at T1 were grade four,which were lower than that at T0 and that of the other three groups at the same time point (x2 =12.935,P＜0.05).There was no significant changes of the median of OAA / S classification at each time point in the other three groups (P＞0.05).In group C,the median of NRS score was three at T1 and was two at T2 respectively,which were higher than that at T0 and that of Group F and group T at the same time point (x2 =13.748,11.616; P＜0.05).There were no significant changes of the median of NRS score in group F,group T and group K within groups (P＞0.05).Analgesic remedy percentages in group C,group F,group T and group K were 16.7％,3.3％,3.3％,6.7％,respectively.The incidence of adverse reactions in group C,group F,group T and group K were 30.0％、23.3％、3.3％、16.7％,respectively.Conclusion Tramadol had efficient analgesic effects and low rate of adverse reactions during vitrectomy under local anesthesia.