皮下患者自控镇痛在高龄肿瘤患者术后镇痛中的应用

Application of subcutaneous patient-controlled analgesia with sufentanil in aged patients after surgery for cancers

目的比较皮下患者自控镇痛（PCA）和静脉PCA在高龄肿瘤患者术后镇痛的应用效果。方法全麻肿瘤手术患者99例,年龄80~92岁。术后镇痛：S组61例,采用皮下PCA,于手术结束前约1h行上臂三角肌前区皮下穿刺留针,连接无线镇痛泵;I组38例,术后实施静脉PCA。镇痛药配方：S组,舒芬太尼7μg/kg＋0.75%左布比卡因20ml＋雷莫司琼0.6mg＋0.9%氯化钠至150ml;I组,舒芬太尼5μg/kg＋雷莫司琼0.6mg＋0.9%氯化钠至150ml。镇痛方法：背景剂量1.5ml/h,PCA单次量1.2ml,锁定时间10min。评估术后2、24和48h的数字等级评分量表（NRS）评分,记录不良反应。结果两组术后镇痛效果满意,各时点NRS评分相仿（P〉0.05）。S组患者镇痛期嗜睡、恶心呕吐、低血压发生率低于I组（P〈0.05）。结论与静脉PCA比较,高龄肿瘤患者术后使用皮下PCA镇痛效果相仿,但使用方便,对全身影响较小。

Objective To investigate the efficacy of subcutaneous patient-controlled analgesia（PCA）with sufentanil in aged patients after surgery for cancers.Methods Ninety-nine patients aged80 to 92years old underwent radical surgery for cancers,who received postoperative subcutaneous PCA（group S,61cases）or intravenous PCA（group Ⅰ,38cases）.Subcutaneous PCA in group S was performed via a needle kept subcutaneously in the deltoid area of the upper arm with the analgesic solution of sufentanil 7μg/kg plus 0.75% levobupivacaine 20 ml,ramosetron 0.6mg and normal saline 150 ml.Group Ⅰ was given conventional intravenous PCA with sufentanil 5μg/kg plus ramosetron 0.6mg and normal saline 150 ml.Analgesic variables were set up as a background infusion of 1.5ml/h and a PCA dose of 1.2ml in 10 minutes of lockout interval.The NRS scores were evaluated at 2,24 and 48hours after surgery and analgesia-related adverse effects were recorded during analgesia.Results Analgesia was satisfectory showed by similar lower NRS scores in both groups（P0.05）.The incidence rates of drowsiness,nausea and vomiting,and hypotension were lower in group S than those in group Ⅰ（P0.05）.Conclusion A satisfectory analgesia can be obtained by either subcutanious or intravenous PCA with sufentanil.Compared to intravenous PCA,subcutaneous PCA has the advantages of simple practice and less systemic effects.