舒芬太尼用于局麻手术中镇静和镇痛的研究

Evaluation of sufentanil for!sedation and analgesia during operation under local anesthesia

目的评价舒芬太尼对局麻手术患者的镇静和镇痛效果。方法60例ASAⅠ或Ⅱ级择期整形外科手术患者,男21例,女39例,随机均分为芬太尼恒速输注组(F组),舒芬太尼恒速输注组(S组),舒芬太尼靶控输注(TCI)组(TCI组)。在局部麻醉前5min,F组用负荷剂量芬太尼1μg/kg,随后起始速率1μg.kg-1.h-1持续输注;S组负荷剂量舒芬太尼0.1μg/kg,起始速率0.1μg.kg-1.h-1持续输注;TCI组起始血浆靶浓度0.2ng/ml,随后减为0.1ng/ml维持。各组均静脉复合咪唑安定。结果在局麻时(T1)和手术中(T2),TCI组VAS显著低于其他两组(P<0.01),Ramsay达Ⅳ级的例数显著多于F组(P<0.05)。在T1时点,TCI组咪唑安定用量及术中总用量较其他两组少(P<0.01),阿片药总用量较F组少(P<0.05)。术后24h随访TCI组中对T1、T2完全遗忘例数较F组多(P<0.05)。结论舒芬太尼可以安全有效用于镇静和镇痛,TCI效果更佳。

Objective To evaluate the efficacy and safety of intravenous sufentanil for sedation and analgesia during surgery under local anesthesia. Methods Sixty ASA class Ⅰ or Ⅱ patients （21 male, 39 female） undergoing the elective plastic surgery and requiring sedation and analgesia were randomly divided into three groups with 20 patients each. Continuous infusion of fentanyl was used in group F, sufentanil infusion was given in group S and target controlled infusion of sufentanil in group TCI. Five minutes before local anesthesia, fentanyl was given at a loading dose of 1 μg/kg and followed by infusion of 1μg · kg^-1 · h^-1 in group F,sufentanil a loading dose of 0.1 μg/kg followed by infusion of 0. 1 μg ·kg^-1·h^-1 in group S,and sufentanil by target controlled infusion of 0.2-0.1 ng/ml in group TCI. Midazolam was used in three groups. Result There were no significant differences among three groups in awaking time,vital signs including BP, HR, SpO2 , RR and side effects including nausea, emesis, nightmare, blurred vision. VAS of TCI group was significantly less than that of group F and S at T1 and T2 （P〈0.01）. The patients of RSS at grade IV were more in group TCI than those in group F at T1 and T2 （P〈0.05）. Midazolam requirement was significantly less in group TCI than that in group F and S at T1 （P〈0.01）. The total amount of opioid in group TCI was lower than that in group F （P 〈 0.05）. Conclusion Sufentanil is effective and safe for sedation and analgesia, especially given by TCI.