腹部手术后舒芬太尼持续硬膜外镇痛与静脉镇痛的比较

Comparision of Continuous Epidural and Intravenous Sufentanil Infusion

采用双盲、前瞻性研究,在60例年龄30岁~50岁,ASAⅠ-Ⅱ级,BMI(Body mass index体重指数)<30kg/m2,择期行下腹部手术患者中施行舒芬太尼术后镇痛。随机分为2组:硬膜外镇痛组(E组)和静脉镇痛组(I组),比较舒芬太尼术后持续静脉输注与静脉输注的半数有效浓度及副作用。结果显示E组舒芬太尼持续硬膜外输注的EC50(median effective concentration半数有效浓度)为0.87μg/ml,95%的可信区间为0.79μg/ml^0.96μg/ml;I组舒芬太尼持续静脉输注的EC50为0.63μg/ml,95%的可信区间为0.55μg/ml^0.70μg/ml;恶心、呕吐、皮肤瘙痒发生率两组相似,Rammsay评分I组>E组。因此,舒芬太尼持续静脉输注的效价大于硬膜外输注,而硬膜外输注镇痛呼吸抑制副作用更少;并推测椎管内应用舒芬太尼主要作用部位仍在脊髓以上中枢。

To compare the potency, the median effective concentration（EC50）and side effects of epidural and intravenously administered sufentanil for postoperative pain relief,using a double-blind,prospective design, 60 ASAⅠorⅡ patient aged 30～50 yr with body weight index ﹤30kg/m^2 scheduled for lower abdominal operations during epidural anesthesia were randomized into one of two groups：group E （epidural） and group Ⅰ （intravenous）.The results show that the EC50of sufentanil in Group E was 0.87μg/ml （95% confidence interval was between 0.79μg/ml and 0.96μg/ml）;the EC50 of sufentanil in Group Ⅰ was 0.63μg/ml （95% confidence interval was between 0.55 μg/ml and 0.70μg/ml）;The severity of nausea,pruritus were similar for both groups.The scores of Rammsay in group Ⅰ were significantly higher than in those who received epidural sufentanil.Therefore the potency of continuous intravenous sufentanil infusion is significantly greater than epidural route.This suggest that when sufentanil is administered epidurally the primary mechanism is via systemic absorption to produce supraspinal analgesia.