开胸手术后不同浓度舒芬太尼混合罗哌卡因病人自控硬膜外镇痛的效果

Different concentration of sufentanil combined with 0.125% ropivacaine for postoperative patient-controlled epidural analgesia after general thoracic surgery

目的比较开胸手术后不同浓度舒芬太尼混合罗哌卡因病人自控硬膜外镇痛(PCEA) 的效果。方法36例择期开胸行肺叶、食管及纵隔肿瘤切除术后的病人,ASAⅠ-Ⅲ级,年龄21-64 岁,体重42-79kg。随机分为3组(n=12),A、B、C组术后分别用0.4、0.5、0.6 μg/ml舒芬太尼混合0.125%罗哌卡因PCEA。分别于术后4、8、20、24、48 h记录VAS评分、镇痛药液用量、PCA的按压次数、生命体征(脉搏血氧饱和度、呼吸频率、心率及平均动脉压)、镇静及副作用(恶心、呕吐、皮肤瘙痒、胸闷等),并计算PCA按压次数比。结果术后48 h之内,C组VAS评分低于A、B组(P<0.05或0.01),B组实际PCA按压次数低于A组(P<0.05),C组镇痛药液用量、实际PCA按压次数低于A、B 组(P<0.05),PCA按压次数比高于A组(P<0.01)。术后生命体征平稳,镇静、恶心、呕吐、皮肤瘙痒及胸闷的发生率低。结论开胸手术后0.6 μg/ml舒芬太尼混合0.125%罗哌卡因PCEA镇痛效果最好,且不增加用药量及副作用。

ObJective To compare the analgesia and side-effects of different concentrations of sufentanil combined with 0.125% ropivacaine for postoperative epidural analgesia after general thoracic surgery. Methods Thirty-six ASA Ⅰ-Ⅲ patients （25 males, 11 females）ages 21-64 yrs weighing 42-79 kg undergoing elective general thoracic surgery under general anesthesia were randomly assigned to receive patient-controlled epidural analgesia （PCEA） with 0.125% ropivacaine combined with sufentanil 0.4 （group A, n = 12）, 0.5 （group B, n=12） or 0.6 μg·ml^-1 （group C, n=12）. Epidural catheter was placed at T7,8 or T7,9 interspace. The PCEA pump was set up with back ground infusion of 2 ml·h^-1, a 3 ml bolus dose and a 30-min lock-out period. VAS scores was used to assess analgesia at rest and during movement. The total bolus doses, PCEA button pressing times （effective/actual）, vital signs including MAP, HR, respiratory rate, SpO2 and side effects （nausea, vomiting, pruritus and dyspnea） were recorded. Results During the 48 hours after operation the VAS scores in group C were significantly lower than those in group A and B （P〈0.05 or 0.01）. The total amount of PCEA solution consumed and the actual PCEA button pressing times were significantly less in group C than in group A and B （P〈0.05）. The vital signs were stable and the incidence of side-effects was low.Conclusion The combination of 0.125 % ropivacaine with sufentunil 0.6 μg·ml^-1 provides optimal analgesia without increase in the consumption of snfentanil and side-effects.