妇科腹腔镜术后单次应用芬太尼或舒芬太尼镇痛的量效关系研究

The Dose-response Analysis of Fentanyl and Sufentanil for Postoperative Pain Management after Gynecological Laparoscopy

目的:探讨芬太尼或舒芬太尼单次给药用于妇科腹腔镜术后镇痛的量效关系。方法:妇科腹腔镜术后患者120例,随机双盲分为12组,分别单次给予芬太尼0.25μg/kg、0.50μg/kg、0.75μg/kg、1.00μg/kg、1.25μg/kg、1.50μg/kg或舒芬太尼0.025μg/kg、0.050μg/kg、0.075μg/kg、0.100μg/kg、0.125μg/kg、0.150μg/kg,每组10例。记录给药前及给药后5分钟、10分钟、20分钟、30分钟平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)及疼痛视觉模拟评分(VAS)、Ramsay镇静评分、呼吸抑制情况、镇痛是否有效。计算两药半数有效量(ED50)、80%有效量(ED80)及95%有效量(ED95)。结果:舒芬太尼0.125μg/kg组1例患者给药后出现呼吸抑制(SpO2<90%)。舒芬太尼0.150μg/kg组给药后5分钟、10分钟、20分钟、30分钟与给药前比较Ramsay镇静评分均升高(P<0.05),除芬太尼0.25μg/kg组之外,每组均有部分患者镇痛有效。芬太尼单次给药腹腔镜术后镇痛ED50、ED80、ED95分别为1.099μg/kg、1.583μg/kg、2.045μg/kg;舒芬太尼单次给药腹腔镜术后镇痛ED50、ED80、ED95分别为0.074μg/kg、0.127μg/kg、0.178μg/kg。结论:两药均能为妇科腹腔镜患者提供有效术后镇痛;推荐使用芬太尼1.583μg/kg或舒芬太尼0.127μg/kg作为术后单次给药首选剂量。给予药物时需密切观察自主呼吸。

Objective：To evaluate the dose-response relationship of signle-dose intravenous fentanyl or sufentanil for postoperative pain management following gynecological laparoscopy. Methods.120 patients after gynecological laparoscopy were randomly assigned into 12 groups,with 10 in each group. They were given either fentanyl （ 0. 25 μg/kg,0.50 μg/kg,0. 75μg/kg, 1.00 μg/kg, 1.25 μg/kg, or 1.50 μg/kg）, or sufen- tanil（0. 025 μg/kg,0. 050 μg/kg,0. 075 μg/kg,0. 100 pg/kg,0. 125 μg/kg, or 0. 150 μg/kg）, respectively. The MAP,HR,RR,SpO2 and VAS pain score and Ramsay sedation score were recorded before and 5 rain, 10 min,20 min, 30 min after administration. Respiratory depression and effective analgesia was also recorded. The ED50,ED80 and ED95 of both fentanyl and sufentanil were calculated. Results： One patient in the sufentanil 0. 125 pg/kg group underwentrespiratory depression（ SpO2 〈90% ）. Ramsay sedation scores 5, 10,20,30 min after administration in the sufentanil 0. 150 μg/kg group was higher than that before it was given. Except fentanyl 0. 25 μg/kg group,every group had effective cases. ED50, ED80 and ED95 of signle-dose intravenous fentanyl for analgesia after laparoscopic surgery was 1. 099 μg/kg,1. 583 μg/kg,and 2. 045 μg/kg, respectively. ED 50, ED 80, andED 95 of signle-dose intravenous sufentanil was 0. 074,0. 127, and 0. 178 μg/kg, respectively. Conclusions：Both fentanyl and sufentanil can provide patients with effective analgesia after gynecological laparoscopy;We recommend single fentanyl 1. 583 μg/kg or sufentanil 0. 127 μg/kg as a preferred dose,and observation of spontaneous breath is required.