舒芬太尼用于髋关节置换术后患者自控硬膜外镇痛的观察

Sufentanil for Patient-controlled Epidural Analgesia after Total Hip Replacement

目的比较舒芬太尼与等效剂量芬太尼在髋关节置换术后患者硬膜外镇痛的临床效果。方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髋关节置换术患者,随机分为两组(n=25)。芬太尼组(A组):芬太尼0.75mg加0.894%甲磺酸哌卡因20mL加生理盐水至100mL;舒芬太尼组(B组),舒芬太尼75μg加0.894%甲磺酸哌卡因20mL加生理盐水至100mL硬膜外镇痛。其中,A组患者于手术结束时,静脉滴注格拉司琼3mg。持续剂量2mL/h,单次给药量(PCA)0.5mL/次,锁定时间15min。观察两组的镇痛效果,恶心、呕吐次数,记录脉搏血氧饱和度、心率、呼吸的变化。结果镇痛泵开机后,B组各时段镇静评分,2分以上者明显多于A组,镇痛评分明显低于A组,有统计学意义(P<0.05),两组术后恶心、呕吐发生率都较低,组间差异无统计学意义(P>0.05)。两组4、12、24h的呼吸频率和脉搏血氧饱和度差异有统计学意义(P<0.05),但48h的呼吸频率和脉搏血氧饱和度无统计学意义(P>0.05)。结论在等效剂量下,髋关节置换术后患者硬膜外镇痛,舒芬太尼明显优于芬太尼。

Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement.Methods From December 2006 to September 2008,fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups,each group had 25 cases.Group A （fentanyl group）：fentanyl mesylate 0.75 mg ＋ 0.894% ropivacaine 20 mL ＋ 0.9% sodium chloride solution to 100 mL; group B （sufentanil group）：sufentanil 75 μg ＋ 0.894% ropivacaine mesylate 20 mL ＋ 0.9% sodium chloride solution to 100 mL epidural analgesia.Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery.Continuous dose was 2 mL/h,with the volume of single dose （PCA） 0.5 mL per time and lockout time of 15 minutes.The analgesic effect,nausea,and vomiting frequency were observed,and the pulse oxygen saturation,heart rate,and breathing changes were recorded.Results After boot analgesia,S sedation scores for each phase and pain score in group B were significantly different compared with those in group A （P0.05）.Both groups had low incidence of nausea and vomiting,and the difference was not statistically significant （P0.05）.The difference of respiratory rate and pulse oxygen saturation at 4 h,12 h,24 h was statistically significant between two groups （P0.05）,but at 48 h the difference was not significant （P0.05）.Conclusion In the equivalent dose,epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.