舒芬太尼在肝脏手术后自控皮下镇痛的作用

Effects of Patient-controlled Subcutaneous Analgesia with Sufentanil after Liver Surgery

目的:观察患者不同剂量舒芬太尼自控皮下镇痛在肝脏手术后的镇痛效果及对血浆皮质醇的影响。方法:肝脏手术患者45例,随机分为3组,每组15例,A组,舒芬太尼3.0μg/kg,B组,舒芬太尼3.5μg/kg,C组,舒芬太尼3.8μg/kg。各组的自控药液中均混合2%盐酸利多卡因200mg加生理盐水至总量100mL。分别于术后3h(T1)、8h(T2)、24h(T3)、48h(T4)及72h(T5)观察并比较休息及咳嗽的疼痛视觉模拟评分及Ramsay评分;并发症的发生率,于术前和术后抽取静脉血测定血浆皮质醇。结果:T2～T5与C组比较,休息时A和B组VAS评分差异均有统计学意义(P<0.05),活动时A组VAS评分差异均有统计学意义(P<0.05);与C组比较,A和B组T2～T4Ramsay评分差异有统计学意义(P<0.05);与T0比较,A组T1～T3血浆皮质醇浓度升高(P<0.05);与C组比较,A组T1～T3血浆皮质醇浓度升高(P<0.05),B组T1～T3血浆皮质醇浓度升高不明显(P>0.05)。结论:3.5μg/kg舒芬太尼皮下镇痛,肝脏手术后效果好,可在一定程度上抑制机体的应激反应,且不良反应发生率低。

Objective To investigate the analgesic effect and influence on plasma cortisol among different dosages of sufentanil by patient-controlled subcutaneous analgesia（PCSA） following liver surgery. Methods Forty five patients following liver surgery were randomized into three groups, Groups A,B and C received sufent- anil 3.0μg/kg, 3.5μg/kg and 3.8μg/kg with PCSA respectively , the different dosages of sufentanil were dilut- ed with 2% lidocaine hydrochloride 200 mg in 100 mL of normal saline in PCSA. The visual analogue scale at rest and cough, Ramsay scores, and side effects happening at 3,8,24,48 and 72 h of postoperation were observed and evaluated.Venous blood samples were taken before surgery and after surgery to determine the concentration of plasma cortisol. Results Compared with Groups C at 8 h to 72 h of post-operation, there were significant differences in VASr Groups A and Groups B（P〈 0.05）, but in VASe, significant differences could be seen in Groups A（P 〈 0.05）. Compared with Groups C Postoperative Ramsay scores： There were significant differences at 8h to 48h of postoperation in Groups A and Groups B（P 〈 0.05）. The concentration of plasma cortisol was higher after surgery than before surgery in Groups A（P 〈 0.05）, and compared with Groups C, there were signifi- cant differences after surgery in Groups A（P 〈 0.05）,but no difference could be seen in Groups B （P 〉 0.05）. Conclusion Sufentanil 3.5 p,g/kg with patient-controlled subcutaneous analgesia after liver surgery was valu- able, with fewer side-effects by inducing remission of the stress reaction of the patient in the postoperative peri- od.