舒芬太尼与芬太尼复合罗哌卡因用于腹部手术后硬膜外镇痛的比较

Ropivacaine combined with sufentail and fentanil for patient-controlled epidural analgesia after abdominal surgery

目的:对比观察等效剂量的舒芬太尼与芬太尼复合罗哌卡因用于腹部手术后硬膜外镇痛的临床效果。方法:选择ASAⅠ～Ⅱ级,择期在硬膜外麻醉下行腹部手术的患者60例,随机分为两组(每组n=30),术后行患者自控硬膜外镇痛(PCEA)。参数设置为负荷剂量(5mL)+持续剂量(3mL/h)+PCA剂量(2mL/次),锁定时间为30min。A组镇痛药物为0.2%罗哌卡因+0.4μg/mL舒芬太尼,B组为0.2%罗哌卡因+2μg/mL芬太尼。随机双盲对比观察术后4、8、12、24h内按压PCA的次数、视觉模拟评分(VAS)、舒适评分,并比较两组患者术后恶心、呕吐、嗜睡等不良反应的发生率及运动神经阻滞情况。结果:(1)两组患者年龄、体重等一般情况和术中局麻药用量无明显差异(P>0.05);(2)前24h内A组的PCA按压次数为(5.2±3.8)次,较B组(7.4±4.6)次明显减少(P<0.05),且A组在术后4、8、12、24h时疼痛评分均略低于B组(P<0.05);(3)术后12、24h舒适评分A组显著高于B组(P<0.05);(4)A组术后恶心、呕吐显著少于B组(P<0.05),嗜睡等不良反应的发生率在两组之间也没有明显差异(P>0.05)。结论:0.4μg/mL舒芬太尼和2μg/mL芬太尼复合0.2%罗哌卡因均可满足术后硬膜外镇痛的需要,但舒芬太尼的镇痛效果明显优于芬太尼。

Objective To investigate the effects of ropivacaine combined with sufentanil and fentanil for patientcontrolled epidural analgesia after abdominal surgery. Methods Sixty patients（ASA Ⅰ - Ⅱ ） were randomly divided into Groups A （0.2% ropivacaine combined with 0.4 μg/mL sufentinal, n = 30） and Group B （0.2% ropivacaine combined with 2 μg/mL fentinal, n = 30）. Patient-controlled epidural analgesia devices were connected for each case after abdominal surgery. Parameters were set-up as following： bolus 5 mL ＋ continual infusion 3 mL/h ＋ PCA 2 mL/press, time limited 30 minutes. The PCA frequency, VAS score, comfortable score, and the rate of postoperative nausea, vomiting, drowsiness were recorded at 4 h, 8 h, 12 h, 24 h after surgery. Results The patients＇ age, body weight, and dosage of regional anesthetic had no differences between two groups （P 〉 0.05）. The PCA frequency in postoperative 24 h was （5.2 ± 3.8） press in Group A, significantly lower than （7.4 ± 4.6） press in Group B （P 〈 0.05）, and VAS scores in Group A were lower than those in Group B at 4 h, 8 h, 12 h, 24 h after surgery （P 〈 0.05）. Comfortable scores in Group A were significantly higher than that in Group B （P 〈 0.05）. The rate of postoperative nausea and vomiting were significantly lower in Group A, but the rate of drowsiness had no differences between two groups. Conclusion 0.4 μg/ mL sufentinal is better than 2 μg/mL fentinal when they combined with 0.2% ropovacaine for postoperative epidural analgesia after abdominal surgery.