不同剂量舒芬太尼持续硬膜外输注术后镇痛效应的比较

Comparison of efficacy of continuous epidural infusion with sufentanil in different doses for postoperative analgesia

目的比较不同剂量的舒芬太尼复合布比卡因持续硬膜外输注用于行中、上腹部手术病人术后镇痛的临床疗效和安全性.方法将60例ASAⅠ～Ⅲ级择期行中、上腹部手术病人随机双盲分为3组(n=20),分别为舒芬太尼3.0μg/kg(S3.0)组,2.5μg/kg(S2.5)组,2.0μg/kg(S2.0)组,均复合0.125%布比卡因和5mg氟哌利多,总量250ml.术后以5ml/h的速度持续输注行硬膜外镇痛.双盲对照观察3组病人术毕及术后2、4、8、20、24、48h的VAS评分、镇静评分、运动阻滞评分及不良反应的发生情况.结果在各时间段,S2.0组的VAS评分与S2.5组和S3.0组相比均有统计学差异(P<0.05),S3.0组的镇静评分与S2.5组和S2.0组相比也有统计学差异(P<0.05),且皮肤瘙痒的发生率也高于后两组(P<0.05).结论硬膜外持续输注2.5μg/kg舒芬太尼复合0.125%布比卡因及氟哌利多5mg用于中上腹部手术术后镇痛效果良好且不良反应少.

Objective To compare the analgesic efficacy and safety of continue epidural infusion of the different doses sufentanil compounded 0. 125 % bupivacaine in patients after middle and epigastric operation. Methods Sixty ASA Ⅰ- -Ⅲ patients, aged 20 - 60, weight 50 - 100kg, underwent elective middle and epigastric operation were randomly divided into three groups of 20 patients（ n = 20）. To give sufentanil 3.0μg/kg（group S3.0）,2.5μg/kg（group S2.5） and 2.0μg/kg（group S2.0） separately. Three groups were compounded 0. 125 % bupivacaine and 5mg droperidol. The total volume was 250ml. The infusion rate was programmed 5ml/ h. The analgesic efficacy and safety were evaluated by：①visual analogue scales （VAS） （0 = no pain, 10 = severe pain ） ;②Ramsay sedation scales; ③Bromage Motor score; and ④side effects such as nausea, vomiting, tickle and respiratory depression were also recorded at 0,2,4,8,20,24 and 48 hour after operation. Results The demographic data （age, height, body weight, MAP and HR before operation） and duration of operation were comparable among three groups. At any time point, the VAS in group S2.0 was significant higher than that in group S2.5 and S3.0 （P 〈0.05）.The Ramsay scale in group S3.0 was higher than that in group S2.5 and S2.0 （ P 〈 0.05）, the incidence rate of tickle in group S3.0 was higher too （ P 〈 0.05）. Conclusion Epi- dural continuous infusion of 2.5μg/kg sufentanil with 0. 125% bupivacaine and 5mg droperidol could provide satisfied analgesic effects and few side effects for patients underwent middle and epigastric operation.