2022 年第 12 期 第 17 卷

舒芬太尼联合氟比洛芬酯和右美托咪定用于开腹结直肠癌根治术后患者静脉自控镇痛的有效性和安全性

Efficacy and safety of sufentanil combined with flurbiprofen axetil and dexmedetomidine in patient-controlled intravenous analgesia after open radical surgery for colorectal cancer

作者：王秀洪 尹露 殷小容 向顺菊 刘飞

英文作者：Wang Xiuhong Yin Lu Yin Xiaorong Xiang Shunju Liu Fei

单位：四川大学华西医院麻醉手术中心，成都610041

英文单位：Anesthesia Operation Center West China Hospital of Sichuan University Chengdu 610041 China

关键词：结直肠癌；舒芬太尼；氟比洛芬酯；右美托咪定；患者静脉自控镇痛；加速康复

英文关键词：Colorectalcancer;Sufentanil;Flurbiprofenaxetil;Dexmedetomidine;Patient-controlledintravenousanalgesia;Enhancedrecovery

• 摘要：

• 目的  观察舒芬太尼联合氟比洛芬酯和右美托咪定用于开腹结直肠癌根治术后患者静脉自控镇痛（PCIA）的有效性和安全性。方法  收集2016年1月至2018年12月在四川大学华西医院行开腹结直肠癌根治术并于术后行PCIA的406例患者的临床资料进行回顾性分析。根据患者术后PCIA用药方案的不同，分为舒芬太尼联合氟比洛芬酯和右美托咪定镇痛组（PCIA-FDS组，221例）和舒芬太尼联合曲马多镇痛组(PCIA-ST组，185例)。2组间比较的主要结局指标为患者术后48 h舒芬太尼用量，次要结局指标包括术后24、48 h静息和活动疼痛视觉模拟量表（VAS）评分、恶心呕吐发生率、首次肛门排气时间、尿管拔除时间、术后住院天数和患者满意度。结果  通过多元线性回归分析确认不同镇痛方案对术后48 h舒芬太尼用量（术后疼痛）具有较高的影响强度。PCIA-FDS组患者术后48 h舒芬太尼用量明显少于PCIA-ST组［（63±11）μg比（121±21）μg］，差异有统计学意义（t=29.708，P<0.001）。PCIA-FDS组患者术后24、48 h静息和活动疼痛VAS评分均明显低于PCIA-ST组，差异均有统计学意义（均P<0.001）。PCIA-FDS组术后48 h恶心呕吐发生率［4.1%（9/221）比10.8%（20/185）］、首次肛门排气时间、尿管拔除时间、术后住院天数均低于/短于PCIA-ST组，患者满意度评分高于PCIA-ST组，差异均有统计学意义（均P<0.05）。结论  舒芬太尼联合氟比洛芬酯和右美托咪定PCIA可明显减少开腹结直肠癌根治术患者术后舒芬太尼用量，改善患者术后疼痛VAS评分，促进胃肠功能恢复，缩短住院时间，可能是开腹结直肠手术加速康复外科理想的镇痛方式。

• Objective  To observe the efficacy and safety of sufentanil combined with flurbiprofen axetil and dexmedetomidine in patient-controlled intravenous analgesia(PCIA) after open radical surgery for colorectal cancer. Methods  The clinical data of 406 patients were collected and analyzed retrospectively, who underwent open radical surgery for colorectal cancer and were given PCIA after surgery in West China Hospital of Sichuan University from January 2016 to December 2018. According to the different postoperative PCIA medication regimen, the patients were divided into sufentanil combined with flurbiprofen axetil and dexmedetomidine analgesia group(PCIA-FDS group, 221 cases) and sufentanil combined with tramadol analgesia group(PCIA-ST group, 185 cases). The main outcome measure for comparison between the two groups was the amount of sufentanil used within 48 h after operation. Secondary outcome measures included visual analogue scale(VAS) scores of resting and active pain at 24 and 48 h after operation, incidence of nausea and vomiting, time of first anal exhaust, time of urinary tube removal, postoperative hospital stay and patients′ satisfaction. Results  Through multivariate linear regression analysis, it was confirmed that different analgesia schemes had great influence intensity on sufentanil dosage (postoperative pain) within 48 h after operation. The dosage of sufentanil in the PCIA-FDS group was significantly lower than that in the PCIA-ST group within 48 h after operation［(63±11)μg vs (121±21)μg］(t=29.708, P<0.001). The VAS scores of resting and active pain in the PCIA-FDS group were significantly lower than those in the PCIA-ST group at 24 and 48 h after operation(all P<0.001). In the PCIA-FDS group, the incidence of nausea and vomiting［4.1%(9/221) vs 10.8%(20/185)］, the time of first anal exhaust, the time of urinary tube removal, and the postoperative hospital stay were lower/shorter than those in the PCIA-ST group, and the patient satisfaction score was higher than that in the PCIA-ST group(all P<0.05). Conclusions  Sufentanil combined with flurbiprofen axetil and dexmedetomidine in PCIA can significantly reduce the dosage of sufentanil in patients undergoing open radical surgery for colorectal cancer, improve the postoperative pain VAS score of patients, promote the recovery of gastrointestinal function, and shorten the hospital stay. It may be an ideal analgesic method of enhanced recovery after open colorectal surgery.