摘要
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.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2009年第6期498-501,共4页
Chinese Journal of Anesthesiology
基金
广州市医药卫生科技重点项目(2006-ZDi-01)
关键词
舒芬太尼
镇痛
病人控制
药物释放系统
子宫切除术
Sufentanil
Analgesia, patient-controlled
Drug delivery systems
Hysterectomy