老年患者腹腔镜胆囊切除术后舒芬太尼替代性镇痛最佳剂量探讨

Optimal Dose Study on Sufentanil in Postoperative Replacement Analgesia for Elderly Patients with Laparoscopic Cholecystectomy

目的:比较不同剂量舒芬太尼用于老年患者在瑞芬太尼和丙泊酚静脉复合麻醉下行腹腔镜胆囊切除术(LC)后替代性镇痛的临床效果和安全性,探讨舒芬太尼用于LC术后替代性镇痛的最佳剂量。方法:ASAⅠ-Ⅲ级择期行腹腔镜胆囊切除术老年患者100例,随机分为4组,每组25例,分别于停用瑞芬太尼后静脉注射舒芬太尼0.04μg/kg(s1组),0.06μg/kg(s2组),0.08μg/kg(s3组)和0.1μg/kg(s4组)。记录4组患者在静脉镇痛后15分钟(T1)、30分钟(T2)、1小时(T3)、2小时(T4)、4小时(T5)等各时间点镇痛、镇静评分,需要再次镇痛的例数及各组可能出现的呼吸抑制、尿潴留、皮肤瘙痒、恶心呕吐等不良反应。结果:s2、s3、s4组在同一时间点上疼痛视觉模拟评分(VAS)差异无统计学意义(p>0.05),与s1组对应值比较,s2、s3、s4组患者在T3、T4时VAS评分显著降低(p<0.01),而且主动要求再次镇痛的例数也少于s1组(p<0.05)。s1组患者在T1时镇静评分(Ramsay)较s2、s3组显著降低(p<0.01),s4组患者在T1时镇静评分(Ramsay)较s2、s3组显著增加(p<0.01)。结论:静脉注射舒芬太尼可作为老年患者在瑞芬太尼和丙泊酚静脉复合麻醉下行LC术后替代性镇痛的有效方法,推荐剂量为0.06μg/kg。

Objective：To evaluate the clinical effect and safety of sufentanil in postoperative replacement analgesia of remifentanil with propofol for total intravenous anesthesia for the aged with laparoscopic cholecystectomy（LC）,and to investigate the optimal dose of sufentanil in postoperative replacement analgesia for aged with LC.Methods：100 cases of elderly patients of ASA class formⅠto Ⅲ scheduled for selective laparoscopic cholecystectomy were randomly allocated into four groups for receiving with sufentanil 0.04μg/kg（group s1,n=25）,sufentanil 0.06μg/kg（group s2,n=25）,sufentanil 0.08μg/kg（group s3,n=25）and sufentanil 0.1μg /kg（group s4,n=25）after stopping intravenous pumping remifentanil and propofol. Visual analogue scales（VAS）,Ramsay scales,the cases of analgesia again and side-effects including respiratory depression,retention of urine,pruritus,nausea and emesis were assessed after 15min （T1）,30min （T2）,1h （T3）,2h （T4） and 4h （T5） of replacement analgesia. Results：There were no significant differences in VAS at one time among group s1,group s2,and group s3. VAS scores in group s2,group s3 and group s4 at T3 and T4 were lower than that in group s1（p0.01）.So did the cases of analgesia again（p0.05）. The Ramsay scores in group s1 was lower at T1 than those in group s2 and group s3 （p0.01）,and the Ramsay scores in group s4 was higher at T1 than those in group s2 and group s3 （p0.01）. Conclusion：Sufentanil intravenous injection was effective and safe for postoperative replacement analgesia after remifentanil with propofol for total intravenous anesthesia for the aged with LC,and the dose of sufentanil 0.06ug/kg can obtained a better replacement analgesia.