布比卡因局部浸润对老年腹部手术患者术后舒芬太尼镇痛剂量的影响

Effect of local bupivacaine infiltration on effective dose of sufentanil for postoperative analgesia in abdominal surgery of elderly patients

目的观察布比卡因局部切口浸润对序贯法测定舒芬太尼术后静脉镇痛用于老年腹部手术的有效剂量的影响。方法选择60例ASAI～Ⅱ级行择期腹部手术老年患者，手术结束前采用拆信封法给予0．25％布比卡因（L组）或0．9％生理盐水（C组）20ml行切口局部浸润，术后行舒芬太尼患者静脉自控镇痛。静脉自控镇痛设置舒芬太尼起始浓度为1．5μ、kg，若术后24h无请求辅助镇痛（有效）或多次请求辅助镇痛（无效）则下一例降低或提高一个浓度梯度（设为0．1μg／kg）；若术后24hVAS评分3分且追加其他辅助镇痛药后无再次请求辅助镇痛药（可疑），则下一例维持浓度不变。结果L组舒芬太尼半数有效效应浓度（EC50）为1．3327μg／kg，其95％CI1．2709—1．3973；C组舒芬太尼EC50为1．5588μg／kg，95％C I1．4969～1．6233，L组舒芬太尼EC50较C组下降14．5％。结论0．25％布比卡因切口局部浸润可减少舒芬太尼行患者自控静脉镇痛药用量。

Objective To observe the effect of local bupivacaine infiltration of incisions on effective close of sufentanil for postoperative intravenous analgesia in abdominal surgery of elderly patients by u- sing sequential determination method. Methods The clinical data of 60 elderly patients with ASA grade I-Ⅱ were selected to undergo selective abdominal surgery and were randomly assigned to two groups （ Group L and Group C ）. Perioperatively, patients received local incision infiltration of either 0.25 % bupi- vacaine（ Group L）or 0.9% 20 ml saline（ Group C）. Postoperatively, patients received patient-controlled sufentanil intravenously. Patients initially received 1.5 μg/kg sufentanil. Bupivacaine was considered ef- fective when the patient did not request supplementary analgesia （SA） within 24 hours. Bupivaeaine was considered ineffective when the patient requested multiple SAs, and the concentration of sufentanil was ad- justed to increase or decrease by 0.1 Ixg,/kg upon each SA request. If visual analog scale（VAS） pain score was 〉3 and no more SA was requested after the initial SA within 24 hours,the effect of bupivacaine was considered questionable and the concentration of sufentanil remained unchanged. Results In Group L,the 50% effective concentration（EC50） of sufentanil was 1. 3327 μg/kg（95% CI 1. 2709 - 1. 3973 ）. In Group C,the EC50 of sufentanil was 1. 5588 μg/kg（95% CI, 1. 4969 - 1. 6233）. The EC50 of sufentanil in Group L was 14.5% lower than that in Group C. Conclusion Local incision infiltration of 0.25% bupiv- acaine may reduce the use of patient-controlled intravenous Sufentanil.