老年腹部全麻手术中舒芬太尼与瑞芬太尼联合镇痛的效果

Effect of Sufentanil combined with Remifentanil in elderly patients during abdominal general anesthesia operation

目的研究舒芬太尼与瑞芬太尼联合在老年全麻手术中的镇痛效果。方法选取2015年3月～2016年3月保定市第二医院收治的90例需全麻手术的老年患者，并将所有患者按照数字表法随机分为A、B、C3组，每组各30例。A组患者在全麻手术中只使用舒芬太尼镇痛，B组患者只使用瑞芬太尼镇痛，C组使用舒芬太尼联合瑞芬太尼镇痛。比较三组患者在气管插管前、插管后、拔管后血压及心率的变化。术后24h内视觉模拟评分（VAS）情况及苏醒过程中躁动的分级情况。结果c组在插管后、拔管后的舒张压、收缩压及心率均明显优于A、B组，差异有统计学意义（P〈0．05）；C组较A、B组术后24h内VAS评分明显降低，差异有统计学意义（P〈0．05）；A组术后苏醒期躁动情况与B组比较，差异无统计学意义（P〉0．05）；但C组术后苏醒期躁动评分2分者占比（56．67％）明显高于A组（30．00％）及B组（26．67％），差异均有统计学意义（P〈0．05）。结论老年全麻手术的患者采用舒芬太尼联合瑞芬太尼的镇痛效果显著，可有效控制血流动力学的平稳，减轻患者苏醒期的躁动，值得临床上推广。

Objective To research the analgesic effect of elderly patients during general anesthesia operation by using Sufentanil combined with Remifentanil. Methods Ninety elderly patients who needed general anesthesia in the Second Hospital of Baoding City were selected from March 2015 to March 2016. All patients were randomly divided into group A, group B and group C, 30 cases in each group. Patients in the group A were treated with Sufentanil during general anesthesia operation. Patients in the group B were treated with Remifentanil during general anesthesia operation, while those in the group C received Sufentanil combined with Remifentanil. Changes of blood pressure and heart rate before intubation, after intubation and extubation, visual analogue scale （VAS） score in 24 h after operation and the level of restlessness in the recovery process were compared among the three groups. Results The diastolic pressure, systolic pressure and heart rate in the group C were significantly better than those in the group A and B after intubation and extubation （P 〈 0.05）. The VAS score within 24 h after operation in the group C was significantly lower than that in the group A and group B （P 〈 0.05）. There was no significant difference between group A and group B on the restlessness in the recovery process （P 〉 0.05）. But proportion of the patients who got 2 points restlessness scale in the group C （56.67%） was higher than that of the group A （30%） and group B （26.67%）, the differences were statistically significant （P 〈 0.05）. Conlusion Sufentanil combined with Remifentanil has good analgesic effect of elderly patients during general anesthesia operation, which can effectively control the hemodynamics, relieve pain and reduce the restlessness of patients in recovery period. It is worthy of wide clinical application.