不同剂量舒芬太尼复合罗哌卡因用于术后硬膜外镇痛效应比较

Comparison of effects of Sufentanil plus Ropivacaine on postoperative epidural analgesia

目的:研究不同剂量的舒芬太尼复合0.125%罗哌卡因用于硬膜外上腹部术后镇痛的临床疗效和安全性。方法:选择60例麻醉风险评级(ASA)I-II级,年龄(56±12.3)岁,在静脉快速诱导气管插管静吸复合全身麻醉下行上腹部手术的病人随机均分为四组,分别为0.125%罗哌卡因(R)组,0.125%罗哌卡因+0.25ug/ml舒芬太尼(R+0.25S)组,0.125%罗哌卡因+0.5ug/ml舒芬太尼(R+0.5S)组,0.125%罗哌卡因+0.75ug/ml舒芬太尼(R+0.75S)组。于T9-11行硬膜外穿刺置管后接入镇痛泵行术后持续硬膜外输注镇痛,观察术后3、6、12、24小时VAS评分,辅助镇痛用药量及恶心、呕吐、皮肤骚痒、呼吸抑制等副作用。结果:(R+0.5S)组和(R+0.75S)组的患者静息和咳嗽时的VAS评分、24小时内辅助镇痛用药量均显著低于(R)组和(R+0.25S)组,(P<0.05);(R)组、(R+0.25S)组、(R+0.5S)组、(R+0.75S)组四组的瘙痒发生率分别为0%、27.2%、54.5%、63.6%,各组间瘙痒的发生率有显著差异(P<0.05)。60例患者均未发生呼吸抑制等严重并发症;四组间的镇静评分、恶心、呕吐发生率无显著性差异。结论:0.5ug/ml舒芬太尼复合0.125%罗哌卡因可取得较佳的镇痛效果及较少的副作用。

Objective： To study the clinical effect and safety of Sufentanil combined with Ropivacaine in postoperative patients with epidural analgesia（EA）. Methods： 60 patients（ages ranged between 56 ± 12.3）, ASA Ⅰ - Ⅱ, undergoing selective upper abdominal surgery under gencral anesthesia, were randomly divided into four groups. Ropivacaine 0.125% was used in group Ⅰ , ropivacaine 0.125% plus sufentanil 0.25ug/ml in group Ⅱ, mpivacaine 0.125% plus sufentanil 0.5ug/ml in group Ⅲ and mpivacaine 0.125% plus sufentanil 0.75ug/ml in group Ⅳ. Postoperative analgesic effects,PEA pump usage, drug consumption and side effects,and visual analogue scales（VAS） were observed at 3,6,12 and 24 hr. Results： VAS and drug consumption in group Ⅲ and Ⅳ within 24 hr were significantly lower than these in group Ⅰ and Ⅱ when patients were in the state of rest or coughing, respectively（P 〈 0.05）; Pruritus incidence in the four groups was 0%, 27.2 % ,54.5 % and 63.6% in proper order, and there was significant difference between the four groups（P 〈 0.05）. All the patients had no severe complications （such as respiratory depression）. Conclusion： In this study, Sufentanil 0.5ug/ml with Ropivacaine 0.125 % could be safe in PEA after UAS, which had the best analgesic effect in the four, with less side effects.