舒芬太尼和芬太尼在肝炎产妇剖宫产术后静脉自控镇痛中的比较

Effect of sufentanil and fentanil in postoperative patient-controlled intravenous analgesia in patients with hepatitis undergoing cesarean

目的比较舒芬太尼和芬太尼在肝炎产妇剖宫产术后静脉自控镇痛(PCIA)中的效果与安全性。方法 120例择期行剖宫产术肝炎产妇,ASAⅠ或Ⅱ级,随机均分为舒芬太尼组(S组)和芬太尼组(F组),术后采用PCIA。S组舒芬太尼2μg/kg+阿扎司琼10mg+生理盐水至100ml;F组芬太尼20μg/kg+阿扎司琼10mg+生理盐水至100ml。记录术后4、8、12、24、48h的VAS镇痛评分、Ramsay镇静评分、BCS舒适度评分;术前及术后第3天的肝功能指标;术后48h内恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应发生率。结果术后4、8、12、24hS组VAS评分明显低于F组(P<0.05)。术后4、8、12hS组Ramsay评分、BCS评分显著高于F组(P<0.05)。术后48h内S组恶心、呕吐发生率明显低于F组(P<0.05);两组患者术后第3天的肝功能与术前差异无统计学意义。结论舒芬太尼镇痛作用优于芬太尼,不良反应轻,对肝炎产妇的肝功能影响不大,可以安全地应用于肝炎产妇剖宫产术后的PCIA。

Objective To compare the effect of sufentaniI and fentanil in postoperative patient- controlled intravenous analgesia （PCIA） in patients With hepatitis undergoing cesarean. Methods One hundred and twenty patients With hepatitis, ASA Ⅰ or Ⅲ, scheduled for cesarean, were randomly divided into sufentanil group （group S） and fentanil group （group F）. Component of PCIA pump in groups S and F was sufentanil 2μg/kg and fentanil 20μg/kg, respectively, both with, azasetron 10 mg and normal saline to a total volume of 100 ml. At 4, 8, 12, 24 and 48 h after operation, visual analog scale （VAS）,Ramsay sedation scale and bruggman comfort scale （BCS） were recorded. Liver function before and at the third day after operation, the incidence of nausea, vomiting, pruritus, and respiratiory depression within 48 h post operation were also recorded. Results At 4, 8, 12, 24 h postoperation, VAS in group S was lower than that in group F（P〈0. 05）. At 4, 8, 12 h postoperation, Ramsay scale and BCS value in group S were significantly higher than those in group F（P〈0. 05）. The incidence of nause and vomiting in groups S was lower than that in group F （P〈 0. 05） within 48 h postoperatively. Liver function at third day after operation in two groups had no significant difference compared with that before operatiorL Conclusion Sufentanil could be safely applied in patients With hepatitis undergoing cesarean due to better analgesia effect, more subtle side-effects, and no effect on liver function in patients with hepatitis.