舒芬太尼与瑞芬太尼联合应用于老年全麻手术中的镇痛效果及安全性观察

Analysis on Analgesic Effects and Safety of Sufentanil Combined with Remifentanil in Elderly Patients with General Anaesthesia Surgery

目的:探讨舒芬太尼与瑞芬太尼联合在老年全麻手术中镇痛的临床效果及安全性。方法:选取广州市花都区第二人民医院2013—2014年收治的需手术治疗的老年患者180例作为研究对象,按随机数字表法分为3组各60例。对照1组患者静脉注射瑞芬太尼0.5μg/kg进行全麻诱导,对照2组静脉注射舒芬太尼0.8μg/kg进行全麻诱导,观察组静脉注射瑞芬太尼0.25μg/kg联合舒芬太尼0.4μg/kg进行全麻诱导。观察3组患者在手术过程中不同时间段的平均动脉压、心率、疼痛评分、呼吸抑制、苏醒时间和躁动情况以及不良反应发生情况。结果:观察组患者各时间段的平均动脉压与对照1组和对照2组比较,差异有统计学意义(P<0.05),但对照1组与对照2组比较,差异无统计学意义(P<0.05)。观察组患者各时间段的心率与对照1组和对照2组比较,差异有统计学意义(P<0.05),但对照1组与对照2组比较,差异无统计学意义(P<0.05)。苏醒时间观察组患者为(5.4±2.2)min,对照1组为(8.4±5.7)min,对照2组为(5.3±2.1)min,观察组与对照2组比较,差异无统计学意义(P>0.05),但对照1组与观察组和对照2组比较,差异有统计学意义(P<0.05)。观察组患者疼痛指数VAS≥4分者2例(3.3%),对照1组4例(6.7%),对照2组48例(80.0%),观察组与对照1组比较,差异无统计学意义(P>0.05),但对照2组与观察组、对照1组比较,差异有统计学意义(P<0.05)。发生呼吸抑制对照1组患者6例(10.0%),对照2组和观察组均无发生,对照1组与观察组和对照2组比较,差异无统计学意义(P>0.05)。观察组患者发生躁动2例(3.3%),对照1组发生4例(6.7%),对照2组发生48例(80.0%),观察组与对照1组比较,差异无统计学意义(P>0.05),对照2组与观察组和对照1组比较,差异有统计学意义(P<0.05)。结论:舒芬太尼联合瑞芬太尼镇痛有利于维持较为稳定的血流动力学,可避免其单独用药时出现的躁动、苏醒时间慢和呼吸抑制等现象,在老年患者的手术中具有更高的安全性。

OBJECTIVE： To probe into the clinical effects and safety of sufentanil combined with remifentanil in elderly patients with general anaesthesia surgery. METHODS： 180 cases of elderly patients undergoing general anaesthesia surgery admitted into Guangzhou Huadu District the Second People＇s Hospital during 2013-2014 were selected to be divided into three groups,with 60 cases in each. In order to carry on the induction of general anesthesia,the control group one were treated with intravenous remifentanil,0. 5 ug / kg; the control group two were given intravenous remifentanil,0. 8 μg / kg; and the observation group received 0. 25 μg / kg remifentanil combined with 0. 4 μg / kg sufentanil. The mean arterial pressure,heart rate,pain score,respiratory depression,awakening time,agitation and incidence of adverse drug reactions in three group of patients were observed during T1-T10.RESULTS： The mean arterial pressure of observation group during T1-T10 compared with control group one and control group two,the difference was statistically significant（ P〈0. 05）; yet there was no significance between control group one and control group two（ P〈0. 05）. The awakening time of observation group was（ 5. 4 ± 2. 2） min,control group one was（ 8. 4 ± 5. 7） min and control group two was（ 5. 3 ± 2. 1） min,there was no significance between the observation group and the two control groups（ P〉0. 05）,yet the difference was statistically significant between the control group one and observation group with control group two（ P〈0. 05）. The pain score of VAS≥4 in observation group was one case（ 3. 3%）,in control group one was two cases（ 6. 7%） and in control group two was 24 cases（ 80. 0%）,there was no statistically significant difference between the observation group and the control group one（ P〉0. 05）; yet the difference was significant between the control group two and the observation group with the control group one（ P〈0. 05）. As for the respiratory depression,there were 3 cases in the control group one（ 10. 0%）,yet no case had been found in the control group two and the observation group,there was no statistically significant difference between the control group one and the observation group with the control group two（ P〉0. 05）. The agitation of observation group was one case（ 3. 3%）,control group one was two cases（ 6. 7%） and control group two was 24 cases（ 80. 0%）,there there was no significance between the observation group and the control group one（ P〉0. 05）,yet the difference was significant between the control group two and the observation group with the control group one（ P〈0. 05）. CONCLUSIONS： Sufentanil combined with remifentanil is beneficial to maintain the stable hemodynamics,and can avoid the phenomenon in terms of agitation,slow awakening time and respiratory depression,etc; which has higher security in elderly patients with surgery.