静脉舒芬太尼和硬膜外舒芬太尼复合罗哌卡因用于术后患者自控镇痛的比较

Comparison of patient-controlled analgesia of intravenous sufentanil and epidural sufentanil combined with ropivaccaine used for postoperative patients

目的比较术后应用舒芬太尼经静脉或经硬膜外复合罗哌卡因进行患者自控镇痛(PCA)的临床效果和安全性。方法选择60例ASAⅠ～Ⅱ级在硬膜外麻醉下行妇科手术患者,随机分为静脉注射舒芬太尼患者自控镇痛(PCIA)组和硬膜外舒芬太尼复合罗哌卡因患者自控镇痛(PCEA)组,每组30例。静脉组PCA药物配方为舒芬太尼100μg+氟哌利多5 mg用生理盐水稀释至100 ml,负荷量3 ml,背景剂量0．5 ml／h,自控给药剂量0．5 ml／次,锁定时间5 min。硬膜外组PCA药物配方为舒芬太尼80μg+氟哌利多5 mg+罗哌卡因250 mg用生理盐水稀释至200 ml,负荷量4 ml,背景剂量2 ml／h,自控给药量3 ml／次,锁定时间30 min。结果两组术后4、8、12、24、48 h各时间点的视觉模似评分(VAS)差异无统计学意义,PCIA组镇静评分均高于PCEA组(P<0．05),PCIA组48 h用药量少于PCEA组(P<0．05),PCIA组总按键次数高于PCEA组(P<0．05),两组患者对术后镇痛总体满意度良至优者百分率差异无统计学意义,不良反应发生率PCIA组较PCEA组高(P<0．05)。结论舒芬太尼经静脉或经硬膜外复合罗哌卡因用于患者术后自控镇痛均可取得安全满意的效果,但舒芬太尼复合罗哌卡因PCEA术后镇痛总体满意度的优率高,按键次数少,不良反应少,更适合于术后镇痛。

Objective To compare the efficacy and safefy of patient-controlled analgesia（PCA） of intravenous sufentanil and epidural sufentanil combined with ropivacaine. Methods 60 patients, ASA Ⅰ-Ⅱ ,undergoing gynecological procedures under epidural anesthesia were randomly allocated to patient-controlled intravenous analgesia（PCIA） group （n = 30 ） or patient-controlled epidural analgesia （PCEA） group （n = 30 ）. In PCIA group, the PCA solution consisted of sufentanil 100 μg, droperidol 5 mg diluted to 100 ml with normal saline, loading dose of 3 ml, background infusion 0.5 ml/h, bolus 0.5 ml, lockout-time 5 rain. In PCEA group, the PCA solution consisted of sufentanil 80 μg, droperidol 5 mg, ropivacaine 250 mg diluted to 200 ml with normal saline, loading dose 4 ml, background infusion 2 ml/h, blous 3 ml, lockout time 30 rain. Results At 4,8,12,24 and 48 h after operation, there were no significant difference between the two group in VAS scale and the overall satisfaction of pain relief. The degree of sedation, the total number of PCA demand and the incidences of side effect were higher in the PCIA group than that in PCEA group （P〈0. 05 ）. The total dosage of sufentanil was less in the PCIA group than that in PCEA group （P 〈0. 05 ）. Conclusion Either intravenous sufentanil or epidural sufentanil combine with ropivacaine is satisfied and safe used for postoperativce pain relief,but the PCEA is better than PCIA.