舒芬太尼在全子宫切除术后镇痛个体化用药的临床观察

Clinical observation on individualized medication of sufentanil for analgesia after total hysterectomy

目的探讨并评价舒芬太尼在全子宫切除术后镇痛的个体化用药,为临床合理用药提供依据。方法选择我院全身麻醉下择期开腹行全子宫切除术65例患者,术前接受P450 CYP3A4＊1G酶基因测定,按检测结果分为2组：A组为野生型纯合子组,B组为突变型纯合子组。术后自愿接受静脉自控镇痛（PCA）治疗。患者均接受全身麻醉,术毕静注0.04μg/kg负荷量舒芬太尼,连接PCA镇痛泵。入PACU后2、4、24、48 h各时点,评估患者的VAS疼痛评分和Ramsay镇静评分。记录舒芬太尼消耗量及恶心呕吐、呼吸抑制不良反应的发生率。结果两组患者2 h和4 h舒芬太尼消耗量组间比较,差异无统计学意义（t=4.21,t=5.36,P〉0.05）,但A组24 h和48 h舒芬太尼消耗量少于B组（t=11.67,t=9.86,P〈0.05）。两组各时间VAS疼痛评分和Ramsay镇静评分比较,差异均无统计学意义（F=3.38,F=3.69,P〉0.05）。两组呼吸抑制发生率比较差异无统计学意义（χ~2=0.09,P〉0.05）,A组恶心、呕吐的发生率明显高于B组（χ~2=4.57,P〈0.05）。结论传统的按公斤体重给予舒芬太尼的术后镇痛配方,患者不良反应发生率高。只有个体化应用,才能既充分保证完善的术后镇痛,又可减少由于镇痛药物过量带来的风险。

Objective To explore and evaluate individualized medication of sufentanil for analgesia after total hysterectomy,and guide the clinical rational drug use.Methods Sixty five patients undergoing total hysterectomy and general anesthesia were chosen,P450 enzyme gene CYP3A4＊ 1G was measured before operation.The patients were divided into two groups according to the test results：group A for the wild type homozygote and group B for the mutant type homozygote.0.04 μg/kg of sufentanil was given intravenously and PCA was used at the end of operation.VAS scores and agitation scores were assessed.The sufentanil consumption,the incidence of adverse reactions were recorded at 2,4,24 and 48 h in PACU.Results There was no significant difference between the two groups in consumption of sufentanil at 2 h and 4 h,but consumption of sufentanil in group A at 24 h and 48 h was less than that of group B（t =11.67,t =9.86,P〈0.05）.There was no significant difference in VAS scores and Ramsay scores at every time point between the two groups（F=3.38,F=3.69,P〈0.05）.The incidence of nausea and vomiting in group A were significantly higher than that in group B（χ~2=4.57,P〈0.05）,while no significant difference was found in the incidence of respiratory depression between the two groups（χ~2 =0.09,P〈0.05）.Conclusion The traditional postoperative analgesia in patients with sufentanil according to weight（kg） could result in high adverse reaction rate,only individualized use of sufentanil can fully guarantee the perfect postoperative analgesia,and reduce the risks of drug overdose.