舒芬太尼联合罗哌卡因在高龄患者下肢手术术后镇痛的研究

Research of postoperative epidural analgesia for sufentanil combined with ropivacaine under lower limb surgery in elderly

目的 探讨舒芬太尼联合罗哌卡因在高龄患者下肢手术术后患者自控硬膜外镇痛（PCEA）使用的安全性和合适浓度.方法 择期行下肢手术的高龄患者80例,按随机数字表法分为A、B、C、D四组,每组20例,术后PCEA泵内舒芬太尼浓度分别为0.1、0.2、0.3、0.4 μg/ml,并联合0.125%罗哌卡因.记录术后4、10、24、48 h静息状态时视觉模拟评分（R-VAS）、活动状态时视觉模拟评分（C-VAS）、改良Bromage运动神经阻滞评分、Ramsay镇静评分.观察PCEA泵使用情况及其不良反应.结果 术后各时间点A、B组C-VAS、镇痛药用量、有效按压次数明显高于C、D组（P＜0.01或＜0.05）;按压有效率明显低于C、D组（P＜0.05）;而C、D组间比较差异均无统计学意义（P＞0.05）.D组术后10、24 hRamsay镇静评分[（4.5±0.5）、（4.6±0.6）分]明显高于A组[（2.7±0.8）、（2.7±0.8）分]、B组[（2.9±0.9）、（2.7±0.9）分]、C组[（3.0±0.7）、（2.9±0.5）分]（P＜0.05）.四组患者均未发生低血压和呼吸抑制.结论 四种舒芬太尼剂量联合罗哌卡因用于高龄患者下肢手术术后PCEA均安全有效,其中以0.3μg/ml舒芬太尼浓度联合罗哌卡因镇痛效果更好,且不良反应少.

Objective To investigate the safty and proper concentration of using the sufentanil combined with ropivacaine in patient-controlled epidural analgesia （PCEA） under lower limb surgery in elderly. Methods Eighty patients scheduled for lower limb surgery were divided into 4 groups by random digits table with 20 cases in each. The concentration of the sufentanil were 0.1,0.2,0.3 and 0.4 μ g/ml in group A, B, C, D respectively. The concentration of the ropivacaine were 0.125% in each group for the PCEA.R-VAS, C-VAS , Bromage score, Ramsay score, press times ,dosage and side effects were monitored and recorded at 4,10,24 and 48 h after operation. Results Compared with those in group C, D, C-VAS,dosage of the analgesia,press times of PCEA were higher in group A,B （P〈0.01 or 〈 0.05）,the efficacy of press was lower in group A, B（P〈0.05）, but there was no significant difference between group C and group D（P〉0.05 ）.The Ramsay score 10,24 h after operation in group D[（4.5 ± 0.5 ）, （4.6 ± 0.6） scores] was higher than that in group A,B,C [（2.7 ±0.8）, （2.7 ±0.8） scores vs.（2.9 ± 0.9）, （2.7 ± 0.9） scores vs. （3.0 ±0.7）, （2.9 ±0.5） scores] （P 〈0.05）. There were no case with hypotension and respiratory depression.Conclusion PCEA of four methods are safe and effective in elderly which 0.3 μ g/ml sufentanil combined with 0.125% ropivacaine have good analgesic effect and less side effect.