舒芬太尼用于神经外科术后皮下自控镇痛的临床观察

Effect of Patient-controlled Subcutaneous Analgesia with Sufentanil after Craniotomy

目的评价舒芬太尼用于神经外科术后患者皮下自控镇痛(PCA)的效果、安全性和实用性。方法将60例神经外科择期行开颅幕上脑肿瘤切除术后患者分为两组:持续+PCA组(CP组)和单纯PCA组(P组),每组30例。术后镇痛药物为舒芬太尼0.12mg。采用视觉模拟疼痛评分(VAS)对术后2h、20h、24h、44h和48h的镇痛效果进行评估,记录不良反应的发生情况。结果术后20h及24hP组患者主诉疼痛例数多于CP组(P<0.05),两组患者术后各时间点VAS评分差异无统计学意义(P>0.05)。CP组和P组患者术后48h舒芬太尼用药总量分别为(98.73±5.96)μg和(57.25±9.73)μg,差异有统计学意义(P<0.05)。CP组和P组患者均未发生呼吸抑制,对术后镇痛的满意度分别为90%和80%。结论对神经外科患者术后选用持续+PCA模式输注舒芬太尼镇痛效果确切,血流动力学稳定,镇痛总体满意率高。

Objective To evaluate the efficacy and safety of sufentanil used for patient-controlled subcutaneous analgesia （PCSA） with different models after craniotomy. Methods Sixty ASA Ⅰ-Ⅱ patients undergoing craniotomy were randomly divided into two groups with or without background infusion. Sufentanil 0. 12 mg was used via patient-controlled analgesia （PCA） and no loading dose was administered. The PCA device was programmed background infusion of 1 ml/h, bolus dose of 0.5 ml in group of using continuance plus PCA model （group CP） and bolus dose of 0.75 ml without background infusion in group P. Hour limit of 3 ml/h, lockout time of 15 minutes were set in two groups. Postoperative pain was assessed at rest and when moving, using Visual Analogue Scale （VAS） at 2 h, 20 h, 24 h, 44 h and 48 h after operation. Side-effects were also recorded systematically during the first 48 h after surgery. Results No significant differences were observed in patients＇ physical status, fentanyl consumption during operation and anaesthetic time. There were no significant differences in VAS scores between the two groups within 48 h after operation, but the incidence of complaining postoperative pain was significantly more in group P than that in group CP at 20 h and 24 h after surgery （ P 〈0.05）. The cumulative analgesic consumption of sufentanil in group CP and group P were 98.73±5.96 μg and 57.25±9.73 μg, respectively （ P 〈0.05）. Compared with group P, the mean arterial pressure in 20 h and 24 h were significantly lower in group CP （ P 〈0.05）. The sedation degree and the incidence of nausea, vomiting in two groups had no significant differences. No restrain of respiration occurred in two groups. The patients＇ satisfactory rate with PCA in group CP and group P were 90% and 80%, respectively. Conclusion PCSA with sufentanil and continuance plus PCA model is an effective and safe analgesic method after craniotomy.