不同剂量舒芬太尼术后镇痛效果评定及其对老年呼吸功能的影响

Effect of different dosages of sufentanil on breath function and postoperative analgesia effect evaluation in elderly patients

目的观察不同剂量舒芬太尼用于老年人术后镇痛效果及对呼吸功能的影响,找出最佳的用药剂量。方法行择期下腹部手术老年患者60例,ASAⅠ～Ⅱ级,随机分为3组。SL组术毕前30 min静注舒芬太尼0.05μg/kg;SM组术毕前30 min静注舒芬太尼0.1μg/kg;SH组术毕前30 min静注舒芬太尼0.15μg/kg。分别记录拔管前呼吸频率、呼吸末二氧化碳、潮气量,拔管时间,术前、术后及拔管后5 min的收缩压、舒张压、心率、血氧饱和度,术前及拔管后的动脉血气分析二氧化碳分压,拔管后5 min的VAS评分和OAA/S评分。结果与SM组、SH组比较,SL组术后及拔管后5 min的收缩压、舒张压、心率、VAS评分和OAA/S评分都明显升高(P<0.05)。与SL组、SM组比较,SH组拔管前呼吸频率、潮气量都明显降低(P<0.05),术后呼吸末二氧化碳明显升高(P<0.05),拔管后5 min的血氧饱和度明显降低(P<0.05),拔管时间和动脉血气分析二氧化碳分压都明显升高(P<0.05)。结论老年患者行下腹部手术术毕前30 min静注舒芬太尼0.1μg/kg,术后镇痛效果好,呼吸抑制程度轻。

Objective To observe the influence of different dosages of sufentanil on breath function and postoperative analgesia effect evaluation in elderly patients and to explore the optimizing dosage.Methods Sixty elderly patients（ASAⅠor Ⅱ）undergoing elective subabdominal surgery were randomly divided into three groups（n=20）.In SL group,sufentanil 0.05 μg/kg was given intravenously 30 min before the end of surgery.In SM group,sufentanil 0.1 μg/kg was given intravenously 30 min before the end of surgery.In SH group,sufentanil 0.15 μg/kg was given intravenously 30 min before the end of surgery.The frequency of aspiration,EtCO2,the total volume before extubation and extubation time were recorded.Systolic pressure,diastolic pressure,heart rate,SpO2 before and after extubation,PaCO2 5 min after extubation were also recorded.VAS score and OAA/S score 5 min after extubation were evaluated.Results In SL group,systolic pressure,diastolic pressure,heart rate,VAS score and OAA/S score were significantly higher than those in SM and SH group（P0.05）,after operation and 5 min after extubation.In SH group,the frequency of aspiration,the total volume before extubation were significantly lower than those in SL and SM group（P0.05）and EtCO2 after operation in SH group was higher than that in SL and SM group（P0.05）.The extubation time and PaCO2 after extubation in SH group were significantly higher than that in SL and SM group（P0.05）.Conclusion Sufentanil 0.1 μg/kg administers intravenously 30 min before the end of subabdominal surgery for the elderly patients could be the optimizing dosage.The extent of respiratory depression is slight and the intensity of postoperative analgesia is well.