不同剂量舒芬太尼对左旋布比卡因硬膜外病人自控镇痛效应的影响

Effect of different - dose sufentamil on efficacy of levobupivacaine for patient - controlled epidural analgesia

目的研究不同剂量舒芬太尼对左旋布比卡因硬膜外病人自控镇痛效应的影响。方法择期硬膜外麻醉行全子宫切除术后病人100例，ASAⅠ-Ⅱ级，年龄35—60岁，随机分成五组，Ⅰ组：0．125％Levob；Ⅱ组：0．125％Levob＋0．25μg／ml Suf；Ⅲ组：0．125％Levob＋0．5μg／ml Suf；Ⅳ组：0．125％Levob＋0．75μg／ml Suf；Ⅴ组：0．125％Levob＋1．0μg／ml Suf，每组20例。采用视觉模拟评分（VAS）、Ramesay镇静评分、术后运动神经阻滞恢复评分（改良Bromage分级）观察镇痛效果；记录开机后4、8、16、20和24h等共5个时点的BP、HR、RR、SpO2以及静息时和咳嗽时VAS等数值、恶心和呕吐等不良反应及治疗措施。结果五组病人年龄、体重、ASA分级、手术时间、术中利多卡因用量和手术结束前硬膜外腔最后一次给药时间基本相同（P〉0．05）。与Ⅰ组比较，Ⅲ组、Ⅳ组和Ⅴ组4、8、16、20、24h等时间点静息VAS和咳嗽VAS均显著降低（P〈0．05或0．01），Ⅰ组和Ⅱ组组间比较差异无统计学意义（P〉0．05），Ⅲ组、Ⅳ组和Ⅴ组组间比较差异无统计学意义（P〉0．05）。与Ⅰ组比较，Ⅲ组、Ⅳ组和Ⅴ组24h内恶心、呕吐及瘙痒等副反应发生率显著高，Ⅰ组和Ⅱ组组间比较差异无统计学意义。与Ⅰ组比较，Ⅲ组、Ⅳ组和Ⅴ组需追加曲马多辅助镇痛病例数少。各组在4、8、16、加、24h等时间点未观察到血压心率异常变化及呼吸抑制，下肢肌力恢复良好，改良Bromage评分均为0级。结论0．5μg／ml Suf是0．125％levob最佳配伍剂量，镇痛效果好，副反应少，可作为妇科术后首选镇痛方案。

Objective To study effect of different - dose sufentanil on efficacy of levobupivacaine for patient - controlled epidural analgesia. Methods One hundred patients, （ ASA Ⅰ - Ⅱ , age 35 - 60）, scheduled for abdominal hysterectomy under epi- dural anesthesia,were randomly divided into 5 groups （ n = 20） ： group Ⅰ received 0. 125% levobupivacaine, group Ⅱ received 0. 125% levob combined with 0. 25μg/ml sufentanil,group Ⅲ received 0. 125% levob combined with 0.5μg/ml suf, group Ⅳ received 0. 125% levob combined with 0. 755μ/ml suf, group V received 0. 125% levob combined with 1755μ/ml suf. The analgesic effects were assessed by using the visual analog scale （VAS）, Ramsay sedation score, modified Bromage score. The following parameters were recorded at 4,8,16,20,24h after pump infusion： blood pressure, heart rate, respiratory rate ,oxygen saturation,VAS at rest and cough, the adverse events and treatment regiments. Results The general state of health were similar among 5 groups. Compared with group Ⅰ , the VAS were lower in group Ⅲ, Ⅳ, Ⅴ at 4,8,16,20,24h, no diffenrence among group Ⅲ, Ⅳ, Ⅴ, and the incidence of adverse events were higher（ P 〈 0.05 ） in group Ⅲ, Ⅳ, Ⅴ. The Ramsay score were 0 in all 5 groups. There was no statistically difference between group Ⅰ and Ⅱ. The patients need tramadol were fewer in group Ⅲ, Ⅳ, Ⅴ than in group Ⅰ. Conclusion In this study,we demonstrated that at the concentration of 0.5% epidurai sufentanil in combination with 0. 125% levobupivaeaine allowed to obtain a good pain control with a fewer adverse effects.