舒芬太尼和芬太尼用于妇科手术后静脉自控镇痛的比较

Comparation of Sufentanil and Fentanyl for Patient-controlled Intravenous Analgesia After Gynaecologic Surgery

目的比较妇科手术术后等效剂量舒芬太尼和芬太尼静脉自控镇痛的镇痛效果和不良反应。方法将在全身麻醉下行妇科手术的400例患者按随机、对照、双盲的方法分为两组,SF组200例,术后给予舒芬太尼0.5μg.mL-1镇痛,F组200例术后给予芬太尼5μg.mL-1镇痛;记录术后～4,～12,～24 h两组患者静息和运动疼痛视觉模拟评分(VAS)、自控镇痛按压次数和药物消耗量、镇静评分和不良反应。结果 SF组在术后～4,～12 h静息和运动VAS评分均小于F组(P<0.05);术后24 h内自控镇痛按压总次数SF组低于F组(P<0.05);SF组术后呼吸抑制和恶心呕吐发生率低于F组(P<0.05);SF组对镇痛满意的患者自控镇痛药物消耗量个体间变异程度小于F组。结论相比芬太尼,舒芬太尼在带来更好术后镇痛效果的同时,其呼吸抑制和恶心呕吐发生率较低,且个体间用药变异程度较小。

Objective To compare the efficacy and side-effects of sufentanil with fentanyl at equivalent dose for postoperative patient-controlled intravenous analgesia （PCIA） after gynecologic surgery. Methods The total of 400 patients undergoing gynecologic surgery were recruited in this randomized double blind study to receive either intravenous sufentanil at 0.5μg . mL^-1 （group SF） or fentanyl at 5μg . mL^-1（group F） for PCIA. Pain intensity according to visual analogue score （VAS） , PCA opioid consumption as well as pressing frequency, sedative scores and side-effects from 0 to 4 h, 4 to 12 h, 12 to 24 h after administration were recorded. Results Both the VAS scores at rest and motion were fewer in group SF than in group F from 0 to 4 h, 4 to 12 h after surgery （P〈0.05）. The PCIA pressing frequency within 24 h ＂,after surgery was lower in group SF than those in group F （ P〈0.05 ）. The incidences of respiratory depression as well as nausea and vomiting in group SF were lower than those of＇ group S （P〈0.05）. The degree of variation of PCIA opioid consumption in group SF was lower than group S. Conclusion With a lower incidence of side-effects, PCIA with sufentanil can provide better postoperative analgesic efficacy than fentanyl after gynecologic surgery. And the inter-individual variant degree of sufentanil consumption is lower than that of fentanyl.