鞘内注射舒芬太尼超前镇痛用于下肢骨科手术的安全剂量筛选

Safe dosage of intrathecal injection of sufentanil for preemptive analgesia in lower limborthopaedic surgery

目的对鞘内注射舒芬太尼超前镇痛用于下肢骨科手术的安全剂量进行筛选。方法选择ASA分级I～Ⅱ级、于蛛网膜下隙与硬膜外隙联合阻滞下行择期下肢骨科手术患者96例，按随机数字表法双盲分为六组，每组16例。I、Ⅱ、Ⅲ、Ⅳ、V、Ⅵ组鞘内分别给予舒芬太尼0．05、0．10、0．15、0．20、0．25、0μg／Kg及O．5％左布比卡因重密度混合液2．5ml。观察记录痛觉阻滞平面达到T10所持续的时间，术后2,4、6、8、12、24、48h的视觉模拟评分（VAS），术后不良反应。结果I一Ⅵ组痛觉阻滞平面达到T10所持续的时间分别为（245．6±34．2）、（259．3±36．7）、（268．9±37．8）、（286．6±38．8）、（287．7±39．1）、（228．6±31．4）min，Ⅳ组与V组比较差异无统计学意义（P〉0．05），其他各组间比较差异均有统计学意义（P〈0．05）。术后6、8、12、24、48h，Ⅲ组、Ⅳ组与V组VAS比较差异无统计学意义（P〉0．05），均低于其他三组（P〈0．05）。术后I、Ⅱ、Ⅲ、Ⅳ、Ⅵ组均未发生呼吸抑制，V组发生4例。结论鞘内注射舒芬太尼超前镇痛用于下肢骨科手术的最佳安全剂量为0．20μg，kg。

Objective To selected the safe dosage of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery. Methods Selected 96 patients who ASA classification I - II grades undergoing elective lower limb orthopaedic surgery with subarachnoid epidural block down, they were divided into six groups by random number table and double blind method,each group of 16 cases. Group I , II , 19, IV, V, VI received 0.05,0.10,0.15,0.20,0.25,0 μg/kg of intrathecal sufentanil and 2.5 ml of 0.5% levobupivacaine. Observed and recorded the duration of block level of pain to Tl0,visual analog score （VAS） postoperative at 2,4,6,8,12,24,48 h, and side effects. Results The duration of block level of pain to T10 ofgroupI, II, 19, IV, V, VIwas （245.6±34.2）,（259.3±36.7）,（268.9±37.8）,（286.6±38.8）, （287.7±39.1 ）, （228.6±31.4） min. There was no significant difference between group IV and group V （P 〉 0.05 ）, the differences of other groups were statistically significant （P 〈 0.05 ）. Compared with group V, VAS of group m and group IV at 6, 8, 12, 24, 48 h after operation was not statistically significant （P 〉 0.05）, and they were lower than the other three groups （P 〈 0.05）. There were no respiratory depression occurred after operation in group I , 11 , 19, IV, VI,4 cases occurred in group V. Conclusion The best of effective dose of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery is 0.20 μg/kg.