小剂量纳洛酮复合舒芬太尼、罗哌卡因用于老年全髋置换患者术后硬膜外自控镇痛

Low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement

目的:评价硬膜外小剂量纳洛酮复合舒芬太尼、罗哌卡因用于老年全髋置换患者术后硬膜外自控镇痛(PCEA)的效果及安全性。方法:60例ASAⅠ～Ⅱ级老年全髋置换患者,随机分为2组(n=30),分别采用0.15%罗哌卡因+0.5μg/ml舒芬太尼(C组)和0.15%罗哌卡因+0.5μg/ml舒芬太尼+0.09μg/(kg.ml)纳洛酮(N组)进行PCEA。双盲随访两组患者,记录镇痛开始后2、6、12、24h视觉模拟评分(VAS),评价镇痛效果,并记录手术后恶心呕吐、皮肤瘙痒、过度镇静、呼吸抑制和低血压等不良反应的发生情况。结果:镇痛后6、12、24h,N组VAS评分明显低于C组(P<0.01);N组患者恶心呕吐的发生率明显低于C组(P<0.05);两组患者其他不良反应无统计学差异;两组患者镇痛期间生命体征平稳,未发生呼吸抑制和低血压。结论:硬膜外小剂量纳洛酮可增强舒芬太尼的镇痛作用,在完善术后监测的同时小剂量纳洛酮复合舒芬太尼、罗哌卡因可安全有效地用于老年人全髋置换术后PCEA。

Objective：To evaluate the effect and safety of low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia（PCEA）in elderly patients undergoing total hip replacement.Methods：A total of 60 elderly patients（ASAⅠ-Ⅱ）undergoing total hip replacement were randomly assigned to two equal groups：Group C was given 0.5 μg/ml sufentanil in 0.15% ropivacaine,Group N was given the same solution with 0.09 μg/（kg·ml）naloxone.The 2 groups were followed up in a double-blinded manner：the visual analogue scale（VAS）for pain score was recorded at 2,6,12,and 24 h to evaluate the analgesia effect.Meanwhile,the incidences of postoperative nausea and vomiting（PONV）,pruritus,sedation,respiratory depression,and hypotension were also recorded.Results：The VAS pain score in Group N was significantly lower than that in Group C at 6,12 and 24 h（P〈0.01）.The incidence of PONV in Group N was significantly lower than that in Group C（P〈0.05）,the incidences of other opioid-induced side-effects were not significantly different between the 2 groups.During the course of analgesia,the vital signs of 2 groups were stable,no patients had respiratory depression or hypotension.Conclusion：Low-dose epidural naloxone can enhance the analgesic effect of sufentanil.With timely postoperative monitoring,low-dose naloxone combined with sufentanil and ropivacaine is safe and effective for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement.