颌面部骨折内固定术后PCIA应用不同镇痛剂量舒芬太尼的镇痛、镇静效果及不良反应观察

目的 观察颌面部骨折内固定术后患者静脉自控镇痛（patient-controlled intravenous analgesia，PCIA）应用不同镇痛剂量舒芬太尼镇痛和镇静效果及不良反应。 方法 选取73例择期行颌面部骨折内固定术的患者，给予不同剂量的舒芬太尼进行镇痛、镇静，随机分为A组（21例）给予舒芬太尼0.02 μg·kg-1·h-1、B组（27例）给予舒芬太尼0.04 μg·kg-1·h-1、C组（25例）给予舒芬太尼0.06 μg·kg-1·h-1。比较各时间点用药总量、视觉模拟评分（Visual Analogue Score，VAS）、视觉模拟疲劳评分（Visual Analogue Fatigue Score，VAFS）及White镇静评分情况，统计患者术后镇痛不良反应发生情况。 结果 B组和C组术后6 h、12 h、24 h、48 h时VAS和VAFS镇痛评分均明显低于A组（P＜0.05）；而B组与C组术后各时间点VAS和VAFS评分的比较，差异无统计学意义（P＞0.05）；C组术后各时间点White镇静评分均明显高于A、B组（P＜0.05）；而A组与B组各时间点White评分的比较，差异无统计学意义（P＞0.05）。A组与B组头晕、恶心、呕吐发生率明显低于C组（P＜0.05）；而A组与B组不良反应发生率比较差异无统计学意义（P＞0.05）。 结论 静脉持续输注舒芬太尼0.04 μg·kg-1·h-1适宜用于颌面部截骨整形术后PCIA，可获得良好的镇痛效果和较高的安全性。

Analgesic and sedative effects of different doses of sufentanil in PCIA after maxillofacial fracture internal fixation operation and adverse reactions

Objective〖HTSS〗To observe the analgesic and sedative effects of different doses of sufentanil in patient-controlled intravenous analgesia(PCIA) after maxillofacial fracture internal fixation operation and adverse reactions. 〖WTHZ〗Methods〖HTSS〗Seventy-three patients with maxillofacial fracturewere randomly divided into group A(21 cases，sufentanil 0.02μg·kg-1·h-1), group B(27 cases，sufentanil 0.04 μg·kg-1·h-1) and group C(25 cases，sufentanil 0.06 μg·kg-1·h-1). The total amount of medication, Visual Analogue Score(VAS), Visual Analogue Fatigue Score(VAFS) and White sedation score were compared at each time point, and the occurrence of adverse effects of postoperative analgesia was counted. 〖WTHZ〗Results〖HTSS〗The VAS and VAFS scores of group B and group C were significantly lower than those of group A at 6 h, 12 h, 24 h and 48 h after operation(P＜0.05), but there was no significant difference between group B and group C at all time points after operation(P＞0.05); The White sedation scores of group C at all time points after operation were significantly higher than those of group A and group B(P＜0.05); While there was no significant difference between group A and group B at all time points(P＞0.05). The incidence of dizziness, nausea and vomiting in group A and group B was significantly lower than that in group C(P＜0.05), while there was no significant difference in the incidence of adverse reactions between group A and group B(P＞0.05). 〖WTHZ〗Conclusion〖HTSS〗Continuous infusion of sufentanil 0.04 μg·kg-1·h-1 is suitable for PCIA after maxillofacial fracture internal fixation operation, which can obtain good analgesic effect and high safety.