罗哌卡因联合舒芬太尼对高龄患者术后镇痛效果的临床研究

Clinical trial of postoperative analgesic effect of ropivacaine combined with sufentanil in elderly patients

目的观察罗哌卡因复合舒芬太尼用于超声引导下连续臂丛神经阻滞对高龄患者术后的镇痛效果。方法回顾性分析120例进行肘关节手术患者的临床资料,所有患者均进行引导下连续臂丛神经阻滞镇痛,按镇痛药物不同分为对照组与试验组,各60例。对照组给予罗哌卡因镇痛(导管注射0.375%罗哌卡因注射液20 m L),试验组以罗哌卡因复合舒芬太尼镇痛(导管注射0.375%罗哌卡因注射液20 m L+静脉注射50μg舒芬太尼注射液)。用视觉模拟评分(VAS)评估患者术后12,24,48,72 h镇痛情况;比较2组患者术后不同时间罗哌卡因用量;记录2组患者术后相关药物不良反应发生情况。结果对照组患者术后12,24,48,72 h静止VAS分别为(2.47±0.68),(3.64±1.17),(3.46±1.05),(1.85±0.48)分;试验组分别为(1.95±0.43),(2.19±0.52),(2.04±0.61),(1.53±0.39)分;对照组运动VAS分别(3.51±1.07),(4.94±1.56),(4.39±1.75),(4.13±1.36)分;试验组分别为(2.26±0.65),(2.82±0.73),(2.51±0.78),(2.97±1.02)分;对照组术后0~12 h、12~24 h,24~48 h罗哌卡因用量及48 h内总用量分别为(7.84±2.39),(9.59±3.05),(15.37±4.68),(32.73±7.46)mg;试验组分别为(4.56±1.40),(6.37±1.38),(8.96±2.51),(19.92±5.17)mg,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为3.33%,18.33%(P<0.05)。结论罗哌卡因复合舒芬太尼用于超声引导下连续臂丛神经阻滞对高龄患者术后的镇痛效果显著,可有效减少术后罗哌卡因用量及术后相关药物不良反应,其临床疗效显著优于常规自控静脉镇痛。

Objective To explore the postoperative analgesic effect and adverse drug reactions of ropivacaine combined with sufentanil in continuous brachial plexus block guided by ultrasound for elderly patients.Methods The clinical data of 120 patients with elbow surgery were retrospectively analyzed.All patients were treated with continuous brachial plexus block guided by ultrasound,and they were divided into control group and treatment group according to the difference of analgesia drugs,60 cases in each group.Control group was analgesia by ropivacaine(catheter injection 0.375%ropivacaine injection 20 m L),treatment group was analgesia by ropivacaine combined with sufentanil(catheter injection 0.375%ropivacaine injection 20 m L+intravenous drippingsufentanil injection 50μg).The analgesia situation of patients at 12,24,48,72 h post-operation were evaluated by visual analogue scale(VAS);the ropivacaine dosage different times post-operation in two groups were compared;the post-operative related adverse drug reactions in two groups were recorded.Results The static VAS at 12,24,48,72 h post-operation in control group were(2.47±0.68),(3.64±1.17),(3.46±1.05),(1.85±0.48)scores,treatment group were(1.95±0.43),(2.19±0.52),(2.04±0.61),(1.53±0.39)scores;the motion VAS in control group were(3.51±1.07),(4.94±1.56),(4.39±1.75),(4.13±1.36)scores,treatment group were(2.26±0.65),(2.82±0.73),(2.51±0.78),(2.97±1.02)score;the ropivacaine dosage in 0-12 h,12-24 h,24-48 h post-operation and within 48 h post-operation in control group were(7.84±2.39),(9.59±3.05),(15.37±4.68),(32.73±7.46)mg,treatment group were(4.56±1.40),(6.37±1.38),(8.96±2.51),(19.92±5.17)mg,all with significant difference(all P<0.05).The incidence of adverse drug reactions in treatment group and control group were 3.33%,18.33%,with significant difference(P<0.05).Conclusion The postoperative analgesic effect of ropivacaine combined with sufentanil in continuous brachial plexus block guided by ultrasound for elderly patients is remarkable,which can reduce the ropivacaine dosage post-operation and related a dverse drug reactions,the clinical effect is better than conventional self-control intravenous analgesia.