子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Efficacy and safety of patient-controlled analgesia with target controlled sufentanil infusion after abdominal total hysterectomy

目的评价子宫切除术后舒芬太尼病人自控-靶控镇痛（PCA—TCI）的安全性和有效性。方法择期经腹子宫切除术病人60例，ASAⅠ或Ⅱ级，年龄20～59岁，体重45～75k，术毕采用视觉模拟评分法（VAS评分）评价疼痛程度，随机分为3组（n=20），Ⅰ组VAS评分=0时进行PCA—TCI，初始血浆靶浓度为0．08μg／L；Ⅱ组VAS评分≥2分时进行PCA—TCI，初始血浆靶浓度为0．08μg／L；Ⅲ组VAS评分≥2分时进行PCA—TCI，初始血浆靶浓度为0．1μg／L；PCA锁定时间为6min。于PCA—TCI启动前即刻（T0）和启动后1h（T1）、2h（T2）、4h（T3）、8h（T4）、16h（T5）和24h（T6）时，记录平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、VAS评分和脑电双频谱指数（BIS）。于T1-6时记录总按压次数（D1）和有效按压次数（D2）。记录术后24h内舒芬太尼用量和不良反应发生情况。结果各组各时点HR、MAP、RR和SpO2均在正常范围内，BIS均大于85，组内和组间比较差异无统计学意义（P〉0．05）。与T0时比较，Ⅰ组T1-6时VAS评分差异无统计学意义（P〉0．05），Ⅱ组和Ⅲ组T1-6时VAS评分降低（P〈0．05）。与Ⅰ组比较，Ⅱ组T0～2时和Ⅲ组T0,1时VAS评分升高，Ⅱ组术后0—2h时和Ⅲ组术后0～1h时D1和D2升高，Ⅱ组和Ⅲ组术后24h内舒芬太尼用量升高（P〈0．05）。各组病人术后均未见心动过速、心动过缓、低血压、呼吸抑制和镇静过度等的发生。结论子宫切除术后舒芬太尼PCA—TCI是安全、有效的，在术后疼痛尚未出现时进行PCA—TCI，且初始血浆靶浓度为0．08μg／L的镇痛效果更好。

Objective To investigate the efficacy and safety of patient-controlled analgesia （PCA） with target controlled infusion （TCI） of sufentanil after abdominal total hysterectomy. Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration （CP） of sufentanil was set at 0.08 μg/L in group Ⅰ and Ⅱ and at 0.1 μg/L in group Ⅲ. The operation was performed under combined spinal-epidural anesthesia with 0.75% bnpivacaine （for spinal） and 2% lidocaine （for epidural）. The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain （VAS = 0） in group Ⅰ and when VAS≥2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0. 005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0. 005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before （T0） and at 1, 2, 4, 8, 16, 24 h （T1-6） after TCI was started. The number of attempts （D1） and successfully delivered doses （ D2 ） was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were 〈 3 and significantly higher in group Ⅱ and Ⅲ than in group Ⅰ. The total amount of sufentanil administered during the 24 h after operation was significantly larger in group Ⅱ and Ⅲ than in group Ⅰ. The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group Ⅰ . Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.