BMI对行胸腔镜下肺癌根治术老年病人术后舒芬太尼个体化镇痛效果的影响

Effect of BMI on the individualized analgesic effect of sufentanil in elderly patients undergoing thoracoscopic radical resection of lung cancer

目的 探讨2 μg/kg的舒芬太尼静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)方案在不同BMI病人行胸腔镜下肺癌根治术围术期的镇痛效果及安全性。方法 选取行胸腔镜下肺癌根治术的病人168例为研究对象,BMI<18.5的病人作为A组(45例),BMI为18.5~24.0的病人作为B组(71例),BMI>24.0的病人作为C组(52例),对3组病人的镇痛效果、镇痛泵按压次数及镇痛不良反应进行比较。结果 术后24、48 h,A组静息痛评分明显高于术后清醒时,且明显高于同时点B组及C组,差异均有统计学意义(P<0.05);术后48 h,A组的咳嗽痛评分均高于B组及C组,差异均有统计学意义(P<0.05)。3组间术后24、48 h的镇痛泵按压次数差异均有统计学意义(P<0.05)。3组在恶心呕吐、皮肤瘙痒及过度镇静等不良反应发生率方面差异均无统计学意义(P>0.05)。结论 BMI可能影响舒芬太尼对行胸腔镜下肺癌根治术的老年病人的个体化镇痛效果。对于BMI<18.5的老年病人,按体质量计算舒芬太尼PCIA用量时,可适当地增加舒芬太尼剂量。

Objective To investigate the analgesic effect and safety of patient-controlled intravenous analgesia(PCIA) of 2 μg/kg sufentanil in the patients with different body mass index(BMI) undergoing thoracoscopic radical resection of lung cancer during the perioperative period.Methods A total of 168 patients who underwent thoracoscopic radical resection of lung cancer were enrolled in this study.The patients with BMI18.5 were divided into group A(n=45),the patients with BMI of 18.5~<24.0 divided into group B(n=71),and those with BMI>24.0 divided into group C(n=52).The analgesic effect,number of analgesic pump compressions and adverse analgesic reactions in the three groups were recorded and compared.Results At the time of 24 and 48 hours after surgery,the score of resting pain in group A was significantly higher than that during postoperative wakefulness,and significantly higher than that in group B and group C at the same time point(P<0.05).Forty-eight hours after surgery,the cough pain score in group A was higher than that in group B and group C(P<0.05).There were statistically significant differences in the number of analgesic pump compressions among the three groups 24 and 48 hours after surgery(P<0.05).There were no statistically significant differences in the incidence rate of adverse reactions such as nausea,vomiting,skin itching,and excessive sedation among the three groups(P>0.05).Conclusions BMI may affect the individualized analgesic effect of sufentanil in the elderly patients undergoing thoracoscopic radical resection of lung cancer.For the elderly patients with BMI<18.5,the dosage of sufentanil by PCIA calculated according to body mass can be appropriately increased.