舒芬太尼静脉自控镇痛对大面积烧伤患者休克期应激反应的影响

Effect of patient-controlled intravenous analgesia with sufentanil on stress response in patients with large area burn in shock stage

目的探讨舒芬太尼患者静脉自控镇痛(PCIA)对烧伤患者休克期应激反应的影响。方法大面积烧伤休克期患者40例均分为两组。镇痛方法:PCIA组采用舒芬太尼2.5μg/ml+阿扎司琼200μg/ml,负荷剂量1ml,维持剂量1ml/h;传统镇痛组(CAT组)采用肌肉注射哌替啶50mg和异丙嗪25mg。应用VAS法评估镇痛效果,记录不良反应发生情况;分别于镇痛前、镇痛后1、12、24和48h检测患者血糖及血浆应激激素(胰岛素、皮质醇、肾上腺素、去甲肾上腺素浓度和促肾上腺皮质激素)水平。结果与CAT组相比,PCIA组镇痛期VAS疼痛评分下降,血糖及血浆应激激素水平均降低,且不良反应发生率低(P<0.05或P<0.01)。结论与注射哌替啶镇痛相比,大面积烧伤患者休克期采用舒芬太尼PCIA镇痛效果好,能降低机体的应激反应。

Objective To study the effect of patient-controlled intravenous analgesia（PCIA）with sufentanil on the stress response in the patients with large area burn in shock stage.Methods Forty patients with large area burn in shock stage were equally randomized into 2groups.PCIA was used in group A with sufentanil 2.5μg/ml plus azasetron 200μg/ml with loading dose 1ml and maintenance dose 1ml/h.The patients in group B were given intramuscular injection of pethidine50 mg and promethazine 25 mg for postoperative analgesia.Efficacy of analgesia was evaluated by VAS pain score.Blood glucose and plasma stress hormones（insulin,epinephrine,norepinephrine,ACTH）were detected before and at 1,12,24 and 48hduring analgesia.Analgesia-related adverse responses were recorded as well.Results Compared with group B,blood glucose and plasma stress hormones and VAS scores were lower,and adverse responses were less during analgesia in group A（P〈0.05 or P〈0.01）.Conclusion PCIA with sufentanil is better than pethidine injection in obtaining analgesia and reducing the stress response in the patients with large area burn in shock stage.