舒芬太尼对老年患者硬膜外阻滞时罗哌卡因半数有效浓度的影响

Effects of sufentanil on median effective concentration of epidural ropivacaine in elderly patients

目的研究舒芬太尼对老年患者经尿道前列腺切除（TURP）术硬膜外阻滞时罗哌卡因半数有效浓度（EC50）的影响。方法采用随机、双盲、前瞻性研究。择期行TURP手术老年患者66例，随机分为两组，每组33例。单药组仅予罗哌卡因，联合用药组复合舒芬太尼5μg。两组第1例患者罗哌卡因浓度均为0．3％，相邻浓度差为0．025％，以双侧感觉阻滞达到T10为有效指标。根据序贯法调整罗哌卡因浓度，应用Dixon和Massey法计算罗哌卡因EC50。观察两组生命体征、感觉阻滞起效时间等，并记录不良反应。结果共完成58例，每组29例。两组硬膜外给药后各观察时点心率、平均动脉压及手术时间比较均无显著差异（P〉0．05）。单药组罗哌卡因EC5。为0．186％（95％CI：0．173％-0．200％），高于联合用药组[0．136％，95％CI：0．127％～0．144％1，组间差异非常显著（P〈0．01）。两组运动阻滞Bromage评分以及感觉阻滞起效时间均无显著差异（P〉0．05）。两组均无严重不良反应发生，硬膜外注药后5min单药组和联合用药组分别发生低血压2例和1例。结论舒芬太尼复合罗哌卡因硬膜外麻醉用于老年患者行TURP术时，可降低罗哌卡因的EC50，复合舒芬太尼硬膜外阻滞时需降低罗哌卡因的浓度。

AIM To examine the sparing effects of sufentanil on the median effective concentration （Ecso） of epidural ropivacaine in elderly patients undergoing elective transurethral resection of prostate （TURP）. METHODS This was a prospective randomized double-blinded study. Sixty-six male elderly patients scheduled for TURP surgery under epidural anesthesia were randomly allocated to a group receiving ropivacaine （single group） or a group receiving ropivacaine plus sufentanil 5μg （combination group）. The concentration of ropivacaine was determined by a Dixon＇s up-and-down sequential allocation. The first participant received 0.3% of ropivacaine in both groups with an interval of 0.025%. The subsequent concentrations were determined by theresponse of the previous patient （bilateral T10 sensory block） in the same group. Ecso of epidural ropivacaine was analyzed by using the Dixon and Massey method. The vital signs, onset time of sensory block, adverse drug reaction, and so on were observed. RESULTS Fifty-eight patients were included in the data analysis with 29 patients in each group. No significant differences in HR, MAP after epidural administration, and operation time were observed between the two groups （P 〉 0.05）. The Ecso of ropivacaine during TURP surgery was 0.186% （95% confidence interval, 0.173% - 0.200%） in single group, and 0.136% （95% confidence interval, 0.127% - 0.144%） in combination group （P 〈 0.01 ）. No differences in Bromage scale of motor block examination and the onset time of sensory block were observed between two groups （P 〉 0.05）. No serious adverse reactions occurred in both groups. There were 1 and 2 patients developed hypotension in the combination and single group respectively. CONCLUSION Sufentanil addition during surgery of TURP can decrease the Ecso of epidural ropivacaine in elderly patients. The concentration of ropivacaine is needed to reduce when combined with sufentanil.