舒芬太尼使用剂量差异对髋关节置换术后患者镇静镇痛效果及不良反应风险的影响

Influence of sufentanil doses difference on sedation,analgesia effects and risk of adverse effects in patients undergoing elective orthopedics operation

目的探讨术后阿片类药物剂量差异对行择期骨科手术患者镇静镇痛效果及不良反应风险的影响。方法选取舟山医院骨科2015年1月至2017年1月收治行择期髋关节置换术患者120例为研究对象,采用随机数字表法分为舒芬太尼低剂量组(40例)、中剂量组(40例)及高剂量组(40例),分别在术后给予舒芬太尼0.1 μg/kg、0.15 μg/kg及0.2 μg/kg辅助静脉镇痛,比较三组患者术后VAS评分、Ramsay镇静评分,镇痛药物加用率和加用量,不良反应发生率等。结果中剂量组、高剂量组患者术后1 h、6 h及12 h VAS评分均显著低于低剂量组(t=3.56、3.72,4.19、4.33,3.10,2.43,均P<0.05);三组术后Ramsay镇静评分差异无统计学意义(F=1.02、0.47、0.75、0.94,均P>0.05);低剂量组患者术后镇痛药物加用率和加用量分别为22.50%、(78.28±9.54)mg;中剂量组患者术后镇痛药物加用率和加用量分别为7.50%、(63.50±6.02)mg;高剂量组患者术后镇痛药物加用率和加用量分别为5.00%、(62.74±5.88)mg;中剂量、高剂量组患者术后镇痛药物加用率和加用量均显著低于低剂量组(χ^2/F=7.48,8.33,3.26,3.41,均P<0.05);低剂量组、中剂量组患者不良反应发生率均显著低于高剂量组(χ^2=8.12、12.96、7.95、12.02,均P<0.05)。结论择期骨科术后0.15 μg/kg剂量舒芬太尼辅助应用效果优于0.1 μg/kg和0.2 μg/kg,具有临床应用价值。

Objective To investigate the influence of opioids drug doses difference on sedation,analgesia effects and risk of adverse effects in patients undergoing elective orthopedics operation.Methods From January 2015 to January 2017,120 patients undergoing elective orthopedics operation in Zhoushan Hospital were chosen and randomly divided into 3 groups according to the digital table,including low dose group(40 patients) with sufentanil of 0.1μg/kg,moderate dose group(40 patients) with sufentanil of 0.15μg/kg,and high dose group(40 patients) with sufentanil of 0.2μg/kg.The VAS score and Ramsay score after operation,analgesic drugs addition rate,addition dose and incidence of adverse effects among 3 groups were compared.Results The VAS scores of the moderate dose group and high dose group at 1h,6h and 12h after operation were significantly lower than those of the low dose group(t=3.5,3.72,4.19,4.33,3.10,2.43,all P<0.05). There were no statistically significant differences in Ramsay score after operation among 3 groups(F=1.02,0.47,0.75,0.94,all P>0.05). The analgesic drugs addition rate and addition dose of the low dose group were 22.50%,(78.28±9.54)mg,respectively,which of the moderate dose group were 7.50%,(63.50±6.02)mg,respectively,which of the high dose group were 5.00%,(62.74±5.88)mg,respectively.The analgesic drugs addition rate and addition dose of moderate dose group and high dose group were significantly lower than those of the low dose group(χ^2/F=7.48,8.33,3.26,3.41,all P<0.05). The incidence rate of adverse effects in the high dose group was significantly higher than those in the low dose group and moderate dose group(χ^2=8.12,12.96,7.95,12.02,all P<0.05).Conclusion Compared with sufentanil of 0.1μg/kg and 0.2μg/kg,the sufentanil of 0.15 μg/kg on patients undergoing elective orthopedics operation has better analgesia effect.