经腹妇科术后不同浓度舒芬太尼硬膜外自控镇痛的效果观察

The Efficacy of Patient-controlled Epidural Analgesia with Different Concentrations of Sufentanil Added to Ropivacaine after Transabdominal Matemity Operations

目的:评价经腹妇科术后不同浓度舒芬太尼与罗哌卡因配伍硬膜外自控镇痛(PECA)的效果。方法:择期经腹妇科手术的患者75例,年龄28～67岁,ASAⅠ～Ⅱ级,随机分为3组(n=25),Ⅰ组:舒芬太尼0.4μG/mL+0.2%罗哌卡因;Ⅱ组:舒芬太尼0.5μg/mL+0.2%罗哌卡因;Ⅲ组:舒芬太尼0.6μg/mL+0.2%罗哌卡因;3组镇痛药中均加入氟哌啶1.25 mg。手术结束前硬膜外导管连接PCA泵,负荷剂量5mL,背景持续剂量2mL/h,单次给药剂量2mL,锁定时间15min,全程观察24h。观察和记录患者PCA泵开启时和开启后4-5 h、8-10h、12-20h、23-24h各时段视觉模拟法(VAS)评分、Bromage评分、Ramsay评分、各时间段总的进药量、PCA药量和患者镇痛过程中各时间段的HR、BP、SpO_2,以及其他不良反应,如胸闷、头晕、搔痒和恶心呕吐等情况。结果:与Ⅰ组相比较,Ⅱ、Ⅲ组在术后4-5 h、8-10 h、12-20 h时间段内,VAS评分显著降低(p<0.01),Ⅲ组较Ⅱ组评分低,但差异无统计学意义(p>0.05),23.24 h时间段内Ⅲ组也较Ⅰ、Ⅱ评分降低,差异有统计学意义(p<0.05);Ⅰ组中有一例患者在术后10 h时肌肉注射杜冷啶50 mg一次:3组患者24 h镇痛药总用量分别是67±12 mL、59±7 mmL和56+8 mL,Ⅱ、Ⅲ组与Ⅰ组相比较。镇痛药的用量减少,差异有统计学意义(p<0.05);Ⅰ组、Ⅱ组、Ⅲ组中各有2、3、2例患者有恶心呕吐现象,但差异无统计学意义(p>0.05)。3组患者中均未发现有皮肤搔痒和胸闷、呼吸抑制、心动过缓及局麻药中毒现象。结论:0.6μg/mL舒芬太尼复合0.2%罗哌卡因用于经腹妇科术后镇痛效果良好,且不良反应少,是一种较理想的镇痛方法。

Objective： To assess the different concentrations of sufentanil combined with ropivacaine for patients requiring PCEA after transabdominal maternity operations. Methods： 75 patients, age from 28-67 years, requiring PCEA after transabdominal maternity operation were randomly assigned into 3 groups： group Ⅰ were received 0.4μg-mL^-1 sufentanil plus 0.2 % ropivacaine, group II were received 0.5μg·mL^-1 sufentanil plus 0.2 % ropivacaine, and group were received 0.6ug·mL-1 sufentanil plus 0.2% ropivacaine. 1.25 mg of droperidol were added into PCEA pumps in all of the three groups. PCEA pumps were started just after the finish of operations. The loading dose was placed at 5 mL, the background dose was 2 mL·h^-1, bolus was 2 mL, and the lock time was 15 min. The VAS score, the Ramsay sedation score, the total dose, the PCA dose and HR, BP, SpO2 were recorded at the starting time. The side effects were also recorded. Results： Compard with that in group I the VAS score in group II and group III were much lower （P〈0.01）; and compared with that in group Ⅱ the VAS score in group Ⅲ were lower but there was no significiant difference （P〉0.05）. The total dose in group Ⅰ , Ⅱ and Ⅲ were 67 mL, 59 mL, 56 mL, respectively. Compared with that in group Ⅰ, the drug dose were much lower in group Ⅱ and group III （P〈0.05）. The incidence of nausea and vomiting in the 3 groups were separately 2, 3 and 2, but there was no significiant difference （P〉0.05）. No other side effect was recorded in all these three groups. Conclusion： 0.6 μg/mL sufentanil combined with 0.2% ropivacaine in PCEA is an ideal analgesic method with little side-effects.