舒芬太尼在老年髋关节置换术后硬膜外自控镇痛的临床研究

Patient-controlled epidural analgesia of sufentanil in elderly patients after hip replacement

目的:观察使用舒芬太尼硬膜外自控镇痛(PCEA)对老年髋关节置换患者术后镇痛情况及对血清白介素-6(IL-6)水平的影响。方法:择期行人工髋关节置换术手术患者40例,采用腰麻-硬膜外阻滞联合麻醉,随机分为两组:观察组20例,0.2%罗哌卡因+舒芬太尼0.75μg/ml+生理盐水至100 ml硬膜外自控镇痛;对照组20例,患者视觉模拟评分(VAS)>4或者患者要求镇痛时给予酮洛酸氨丁三醇肌内注射30 mg。比较两组患者术后疼痛程度、术后血清IL-6水平变化。结果:术后6,24 h观察组VAS评分均低于对照组(P<0.05);两组术后IL-6均升高(P<0.05),对照组术后IL-6升幅较观察组更高。结论:舒芬太尼硬膜外自控镇痛能有效缓解行髋关节置换术老年患者术后疼痛,降低炎性因子水平,降低应激反应。

Objective： To evaluate the effects of patient-controlled epidural analgesia （PCEA） of sufentanil on the postoperative pain level and plasma IL-6 （interleukin- 6） level of elderly patients after hip replacement. Methods： 40 patients undergoing hip arthroplasty surgery with combined spinal and epidural anesthesia were randomized into two groups. 20 patients in the observation group adopted PECA of sufentanil with 0.2% ropivacaine ＋ 0.75txg/mlsufentanil ＋ 100 ml saline; while another 20 cases in the control group whose VAS 〉 4 or by require were giving intramuscular injection with 30mg ketorolac tromethamine for analgesia. The postoperative pain level and serum IL-,6 level were compared in both groups. Results ： VAS scores of 6 h, and 24 h after operation were lower than theose of the control group （P〈0.05） ; after the operation, IL-6 increased in both groups （P〈0.05）, but much higher in the controlgroup. Conclusion： PCEA of sufentanil can effectively relieve the postoperative pain, reduce the level of inflammatory cytokines and the stress response in the elderly patients with hip replacement.