开腹子宫切除术后硬膜外镇痛舒芬太尼最适剂量的探讨

Optimal dosage of sufentanil in patient-controlled epidural analgesia after hysterectomy

目的探讨妇科开腹子宫切除术后硬膜外镇痛舒芬太尼的最小有效剂量及安全性，以得出硬膜外镇痛中舒芬太尼的最适剂量。方法选择ASAⅠ～Ⅱ级开腹子宫切除术患者100例，根据入院时间先后将患者分为5组，每组剂量采用修正的序贯法计算得出，各组均在连续硬膜外麻醉下手术，术中常规监测ECG、NIBP、HR、SpO2，术毕接硬膜外镇痛泵送回病房，观察相关指标。结果从各组患者术后各时段疼痛强度（P1）比较，可见各亚组中得到满意镇痛效果时舒芬太尼最低有效剂量为48μg，组间结果差异有统计学意义（P〈0．05），各组均有胃肠不良反应。结论通过对各亚组不同剂量舒芬太尼镇痛效果和不良反应发生率的观察，可得出在同等硬膜外镇痛泵输注条件下。舒芬太尼获得满意镇痛效果最低有效剂量为48μg，持续镇痛满意，用于妇科开腹子宫切除术后硬膜外自控镇痛安全有效。

Objective To evaluate the effectiveness and safety of sufentanil in epidural analgesia after hysterectomy and to determine its optimal dosage. Methods According to modified step-up-step-down approach, 100 patients in grade ASA Ⅰ～Ⅱ who received patient-controlled epidural analgesia after hysterectomy were randomly divided into 5 sub-groups with different sufentanil doses. ECG, NIBP, HR, SpO2 were monitored during and after operations. Results The pain intensity（PI）on different time spots in subgroups was statistically different（P〈0.05）, and the minimal dosage of sufentanil with patients＇ satisfaction was 48μg. Conclusion The study suggests that 48μg of sufentanil is the optimal dosage for patient-controlled epidural analgesia after hysterectomy.