静脉与硬膜外泵注舒芬太尼患者自控镇痛的疗效

Efficacy evaluation of patient-controlled analgesia with intravenous or epidural sufentanil

目的:比较术后静脉和硬膜外应用舒芬太尼自控镇痛(PCA)的临床效果和安全性。方法:40例经腹子宫切除术患者随机分为静脉泵注舒芬太尼自控镇痛(PCIA)组和经硬膜外泵注舒芬太尼自控镇痛(PCEA)组,每组20例,两组舒芬太尼负荷量为15μg,PCA药物配方为舒芬太尼500μg+0．9％氯化钠溶液至100 mL。不设背景输注,单次PCA剂量1 mL,锁定时间为5 min。于术后4,8,16,24．48 h随访患者并记录患者生命体征、舒芬太尼累积用量、静止和活动状态下视觉模拟评分(VAS评分)、镇静评分,患者满意度和不良反应。结果:两组患者均取得满意的镇痛和镇静效果,各时间点两组患者生命体征、静止和活动状态下VAS评分、镇静程度(OAAS评分)相互比较差异无显著性(P＞0．05),恶心、呕吐、皮肤瘙痒等不良反应发生率两组患者差异亦无显著性(P＞0．05),PCEA组舒芬太尼累积用量各时间点均高于PCIA组,术后48 h时PCEA组舒芬太尼用量显著高于PCIA组(P＜0．05)。结论:舒芬太尼用于术后患者自控镇痛安全有效,相同剂量舒芬太尼PCIA效果优于PCEA。

Objective： To evaluate the efficacy and safety of patient-controlled analgesia （PCA） with intravenous or epidural sufentanil. Methods： 40 patients undergoing elective hysterectomy were randomly allocated to patient-controlled intravenous analgesia （PCIA） group （n=20） and patient-controlled epidural analgesia （PCEA） group （n=20）. Both groups received a bolus of 15/μg sufentanil. The PCA device was set to deliver sufentanil as a 5/μg bolus followed by a 5 min lockout interval with no background infusion. The efficacy in both groups was compared based on the vital signs including MAP, SP02, HR, respiration rate（RR）, visual analogue scale （VAS） scores at rest and on movement, and accumulative sufentanil doses. The safety was assessed based on incidence of adverse events including sedation, nausea, emsesis and pruritus at 4, 8, 16, 24 and 48 h after operation. Results： Both group showed impressive analgesic responses. No significant differences in vital signs, visual analogue scale scores at rest or on movement, side effects in two groups were found （P〉0.05）. The patients in PCEA group had higher accumulative sufentanil doses than those in PCIA group （P〈0.05）. Conclusion： PCIA with sufentanil is superior to PCEA with sufentanil for post-operational analgesia.