舒芬太尼用于胃肠外科手术患者术后镇痛的负荷剂量研究

目的观察胃肠外科手术患者应用舒芬太尼自控静脉镇痛(PCIA)不同负荷剂量术后镇痛的效果及不良反应,探讨舒芬太尼术后镇痛的最佳负荷剂量。方法择期胃肠外科全麻术后应用舒芬太尼PCIA镇痛患者60例,随机平均分为3组:负荷量5μg组(A组)、负荷量10μg组(B组)、负荷量20μg组(C组)。三组分别在手术结束前30 min给予不同的负荷剂量,在术毕拔管后开始PCIA,泵内舒芬太尼2μg/kg,患者自控镇痛(PCA)量2 mL/次,锁定时间15 min,背景量2 mL/h。记录术后1、4、12、24和48 h的疼痛评分、镇静评分、PCA按压次数、并发症和患者满意度等。结果术后1 h和4 h,B组与C组疼痛评分明显低于A组(P<0.05),C组镇静评分明显高于A组与B组(P<0.05)。术后12、24和48 h,三组疼痛及镇静评分差异无统计学意义。PCA按压次数在术后4 h内B组和C组少于A组(P<0.05),4～48 h三组比较差异无统计学意义。A组和B组恶心呕吐、嗜睡和腹胀发生率低于C组(P<0.05)。术后72 h患者满意度B组和C组明显高于A组(P<0.05)。结论手术结束前30 min给予静注负荷量舒芬太尼10μg镇痛效果良好,且不良反应少。

Research of different loading doses of sufentanil using for analgesia on patients after gastrointestinal operation

Objective To observe the effects of sufentanil with different loading doses in patients controlled intravenous analgesia(PCIA)after gastrointestinal operation,to determine the best loading doses of sufentanil. Methods Sixty patients after gastrointestinal operation were randomly divided into three groups,20 cases in each group.Group A received 5 μg sufentanil,group B received 10 μg sufentanil and group C received 20 μg sufentanil.The loading doses were given 30 min before the end of operation.PCIA(included sufentanil 2 μg/kg) with a bolus dose of 2 mL,lockout interval of 15 minutes and continuous infusion of 2 mL/h was given after extubation.Visual analogue scales(VAS),sedation score,PCA palpation times,adverse effects and degree of satisfaction were observed at 1,4,12,24 and 48 h postoperatively. Results VAS score was lower in group B and group C than that in group A on the first 4 h(P<0.05),no significant difference was observed between group B and group C.Sedation score in first 4 h and the incidence of adverse effects(such as abdominal distention,nausea and vomiting) were lower in group A and group B than those in group C(P<0.05).PCA palpation times were less in group B and group C than those in group A.Degree of satisfaction was higher in group B and group C than that in group A. Conclusion PCIA with 10 μg sufentanil loading dose can provide a good postoperative analgesia effect safely for gastrointestinal surgical patients.