年龄对小剂量舒芬太尼硬膜外自控镇痛效应的影响

Effect of age on patient-controlled epidural analgesia with low-dose sufentanil

目的观察年龄对小剂量舒芬太尼硬膜外自控镇痛效应的影响。方法择期行髋关节和下肢骨科术后病人75例（ASAⅠ-Ⅱ级）,年龄22岁-85岁,根据年龄分为A组（22岁-45岁）、B组（46岁-64岁）和C组（65岁-85岁）,每组25例。术后三组均经硬膜外导管接通并开启电子镇痛泵,三组药物配伍和PCA给药模式相同：负荷剂量5μg,背景剂量1μg／h,PCA追加剂量2．5μg,锁定时间3 min。记录PCA开机给负荷量后0、4 h、8 h、20 h、24 h和48 h舒芬太尼累积用量、VAS评分和不良反应及治疗措施,并计算术后第二天舒芬太尼累积用量。结果术后4 h、8 h、20 h和24 h等时间点A组VAS评分高于B组和C组（P〈0．01）。术后8h和20h等时间点B组VAS评分显著高于C组（P〈0．05）。A组恶心等不良反应发生率高于B组和C组（P〈0．01）。结论年龄以及伴随年龄增加发生的椎管内退行性改变是影响小剂量舒芬太尼PCEA效果的重要因素,其中老年病人效果最好,不良反应少,适宜老年病人选用。

Objective To investigate the influence of age on patient-controlled epidural analgesia （PCEA） with small-dose sufentanil after orthopedic surgery. Methods Seventy-five patients were divided into three groups according age： group A （22y - 45 y）, group B （46y - 64 y） and group C （65y - 85 y）. PCEA was performed with same settings： 5 μg of loading dose, 1 μg/h of background infusion speed, 2.5 μg of superadding dose, 3 min interval of lockout time. Cumulative sufentanil consumption, VAS pain score were recorded at O, 4 h, 8 h, 20 h, 24 h and 48 h of given loading dose. Side-effects were also observed. Results VAS pain score was significantly higher in group A than that in groups B and C at postoperative 4 h, 8 h, 20 h and 24 h （P 〈 0.01）, and lower in group C than that in group B at postoperative 8 h and 20 h （P 〈 0.05）. Cumulative sufentanil consumption of first and second postoperative 24 h in group A was more than that in groups B and C, and was least in group C （P 〈 0.01）. Incidence of side-effects in group A was higher than that in groups B and C. Conclusion Age affects the efficacy of PCEA with small-dose sufentanil. The older the patients, the better the analgesic effect obtains.