舒芬太尼或芬太尼复合罗哌卡因对高龄患者人工股骨头置换术后硬膜外镇痛效果观察

Efficacy of sufentanil or fentanyl combined with ropivacaine for epidural analgesia in artificial femoral head replacement of aged patient

目的观察舒芬太尼或芬太尼复合罗哌卡因对高龄患者股骨头置换术后硬膜外镇痛效果。方法拟行人工股骨头置换术高龄患者60例，ASAⅡ～Ⅲ级，70～90岁，体质量45—80kg，分为两组：芬太尼．罗哌卡因组（F组），舒芬太尼-罗哌卡因组（s组），每组30例。术毕连接硬膜外镇痛泵，其中F组采用0．125％甲磺酸罗哌卡因200ml＋芬太尼4μg／ml，S组采用0．125％罗哌卡因200ml＋舒芬太尼0．5μg／ml。背景输注剂量4ml／h，单次给药量2ml，锁定时间30min。采用视觉模拟评分法（visualanaloguescale，VAS）和改良OAA／S评分法分别评估镇痛效果和镇静情况；观察患者镇痛满意度；观察恶心、呕吐、皮肤瘙痒、低血压、呼吸抑制等不良反应发生情况。结果03S组的VAS评分低于F组，S组术后12h、24h、48h的OAA／S评分低于F组（P〈0．05）；S组满意度优于F组（P〈0．05）。②两组均未见呼吸抑制发生，s组恶心、呕吐、皮肤瘙痒等不良反应发生率低于F组（P〈0．05）。结论0．5μg／ml舒芬太尼复合0．125％罗哌卡因应用于高龄患者股骨头置换术后硬膜外自控镇痛效果优于4μg／ml芬太尼复合0．125％罗哌卡因，且不良反应发生率低。

Objective To investigate the efficacy of sufentanil or fentanyl combined with ropivacaine for epidural analgesia in artificial femoral head replacement of aged patient. Methods The 60 ASA Ⅱ or Ⅲpa- tients aged 70 - 90yr weighing 45 - 80kg undergoing artificial femoral head replacement were divided into 2 groups （ n = 30 each） ： F group （ fentanyl-ropivacaine）, S group （ sufentanil- ropivacaine）. The PCEA （ patient- controlled epidural analgesia） pump was connected with epidural catheter after artificial femoral head replace- ment, F group and S group respectively received fentanyl 4 μg/ml and sufentanil 0. 5 μg/ml combined with 0. 125% ropivacaine. The PCEA pump was programmed to deliver a 2 ml bolus with lockout interval 30 min and background infusion of 4 ml/h. Postoperative pain scores and sedation scores were evaluated respectively using VAS （ visual analog scale, 0-10） and OAA/S. Satisfaction of analgesia were recorded. Side effect such as nau- sea, vomiting, pruritus, hypotension, and respiratory depression were recorded. Results ①The value of VAS in S group were significantly lower than in F group ; the value of OAA/S at 12 h, 24 h and 48 h of postoperative in S group were significantly lower than in F group （ P 〈 0.05 ） ; Satisfaction of analgesia in S group was better than in F group （ P 〈 0.05 ）.② There were no incidence of respiratory depression in F group and S group. The incidences of nausea, vomiting and pruritus in S group were significantly lower than in F group （ P 〈 0. 05 ）. Conclusion The combination of epidural sufentanil 0. 5μg/ml with 0. 125% ropivacaine can provide more sufficient analgesia than fentanyl 4 μg/ml with 0. 125% ropivacaine and less side effect for artificial femoral head replacement of aged patient.