舒芬太尼在上腹部手术后硬膜外镇痛中的应用

Application of Sufentanil in epidural analgesia after upper abd ominal surgery

目的 探讨不同浓度的舒芬太尼用于上腹部手术后硬膜外镇痛的安全性。方法将6 0例ASAⅠ～Ⅱ级于硬膜外联合全麻下行上腹部手术的患者随机均分为4组,分别为0 .15 %罗哌卡因(R)组,0 .15 %罗哌卡因+0 .2 5mg/L舒芬太尼(S) ,即(R +0 .2 5S)组,0 .15 %罗哌卡因+0 .5mg/L舒芬太尼(R +0 .5S)组,0 .15 %罗哌卡因+0 .75mg/L舒芬太尼(R +0 .75S)组。术后接入镇痛泵行持续硬膜外镇痛,观察术后3,6 ,12 ,2 4hVAS评分及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果 R +0 .5S组和R +0 .75S组的患者VAS评分显著低于R组和R +0 .2 5S组(P <0 .0 5 ) ;各组间的瘙痒发生率有显著性差异(P <0 .0 5 ) ,镇静评分、恶心与呕吐发生率无显著性差异。6 0例患者均未发生呼吸抑制等严重并发症。结论 浓度不高于0 .75mg/L的舒芬太尼用于上腹部术后硬膜外镇痛是安全的。

Objective It is to discuss the safety of different c oncentration Sufen tanil in epidural analgesia after upper abdominal surgery. Methods 60 patients w ith ASA I^II degree undergoing upper abdominal surgery under epidural anesthesia combined with general anesthesia were randomly divided into four groups. They w ere 0.15% Ropivacaine (R) group, 0 15% Ropivacaine+0.25 mg/L Sufentanil (R+0.25 S ) group, 0.15% Ropivacaine+0.5 mg/L Sufentanil (R+0.5S) group and 0.15% Ropivaca ine+0.75 mg/L Sufentanil (R+0.75S) group respectively. All the patients were con tinued to receive epidural analgesia with analgesic pump. The visual analog scal es (VAS) score after operation for 3, 6, 12 and 24 h and the untoward reaction s uch as nausea, emesis, itch of skin and respiratory depression were observed. Results The VAS scores in R+0.5S group and R+0.75S group were signif icantly lower than that in R group and R+0.25S group (P<0 05). There were significant dif feren ce on the pruritus incidence among the four groups (P<0.05), but there were no s ignificant difference on the incidences of sedation score, nausea and emesis. Al l the patients had no serious complication such as respiratory depression. Conclusion Epidural analgesia after upper abdominal surgery with Sufent anil of less t han 0.75 mg/L is safe.