舒芬太尼两种注射方式预防老年患者瑞芬太尼复合麻醉后早期疼痛的比较

Sufentanil in preventing acute postoperative pain after remifentanil based anesthesia in elderly patients undergoing abdominal surgery:a comparison between target controlled infusion and bolus injection

目的比较手术结束前靶控输注或单次静脉注射舒芬太尼预防行腹部手术的老年患者瑞芬太尼复合麻醉后早期疼痛的效果。方法将70例行腹部手术的老年患者随机分为靶控输注组(T组)和单次静脉注射组(S组),每组35例。两组均予丙泊酚复合瑞芬太尼全凭静脉麻醉。术毕前30min,T组靶控输注舒芬太尼,效应室浓度保持在0.2μg/L直至术毕;S组单次静脉注射舒芬太尼0.4μg/kg。记录两组舒芬太尼注射前及注射后3、5、10min的心率和平均动脉压,术后睁眼时间、拔管时间、首次出现疼痛时间,患者拔管后15、30、45min的Ramsay镇静评分(RSS评分)和疼痛视觉模拟评分(VAS评分),以及术后并发症的情况。结果S组舒芬太尼注射后3、5、10min的心率较注射前显著减慢,平均动脉压较注射前显著降低(P值均<0.01);T组各时间点心率和平均动脉压的差异均无统计学意义(P值均>0.05)。T组术中舒芬太尼总使用量显著少于S组(P<0.01)。两组间开始输注舒芬太尼的时间、睁眼时间、拔管时间、首次疼痛时间的差异均无统计学意义(P值均>0.05)。T组患者拔管后15、30min的RSS评分显著低于S组(P<0.05);拔管后45min,两组间差异无统计学意义(P>0.05)。两组间各时间点VAS评分的差异均无统计学意义(P值均>0.05)。两组间术后呼吸抑制、恶心呕吐、瘙痒等并发症发生率的差异均无统计学意义(P值均>0.05)。结论瑞芬太尼复合麻醉下老年腹部手术患者术毕前30min靶控输注舒芬太尼,效应室浓度0.2μg/L至术毕,可获得与单次静脉注射0.4μg/kg相似的疼痛预防效果,且注射前后血流动力学波动更小,术后苏醒质量更高。

Objective To compare the efficiencies of sufentanil when administered via target controlled infusion （TCI） and Bolus injection in preventing acute postoperative pain after remifentanil based anesthesia in elderly patients undergoing abdominal surgery. Methods Totally 70 elderly patients were randomly assigned to group T （TCI, n = 35） and group S （Bolus injection, n = 35）. Standardized propofol/remifentanil based general anesthesia was performed. Thirty minutes before the end of surgery, patients in group T received sufentanil TCI with the effect compartment concentration being 0.2 μg/L until the surgeries were finished, while patients in group S received a sufentanil 0.4 μg/kg bolus injection. Heart rate （HR） and mean artery pressure （MAP） were recorded before and after sufentanil were given. The recovery time, including opening eyes, extubating and asking for analgesic were also recorded. Ramsay sedative scale （RSS）, visual analogue scale （VAS） and complications were evaluated. Results In group S, HR and MAP descended after sufentanil was given （P〈0.01） and the hemodynamics was stable in group T. The accumulation of sufentanil in group T was less than that in group S （ P〈 0.01）. Time of opening eyes, extubuting and asking for analgesic were comparable in two groups （P〉0.05）. RSS in group T was lower in the early stage after surgical procedure compared with that in group S （P〈0.05）. VAS and complications such as respiratory depression, nausea and vomiting, or pruritus had no statistical difference between the two groups. Conclusion For elderly patients undergoing abdominal surgery, sufentanil TCI at 0.2 μg/L can obtain the same effect as bolus injection at 0.4 μg/kg in preventing acute postoperative pain after remifentanil based anesthesia, and sufentanil TCI has less influence on hemodynamics and better recovery.