舒芬太尼及芬太尼与吗啡用于子宫切除术后硬膜外镇痛的比较

目的：比较舒芬太尼、芬太尼与吗啡用于子宫切除术后持续硬膜外镇痛的临床镇痛效果和不良反应。方法：选择ASAⅠ或Ⅱ级，在连续硬膜外麻醉下行子宫切除术，术后行硬膜外镇痛的患者120例，随机分为4组，S1组（舒芬太尼0．5μg／mL复合甲磺酸罗哌卡因0．237mg／mL）、S2组（舒芬太尼0．75μg／mL复合甲磺酸罗哌卡因0．237mg／mL）、F组（芬太尼5μg／mL复合甲磺酸罗哌卡因0．237mg／mL）、M组（吗啡0．06mg／mL复合甲磺酸罗哌卡因0．237mg／mL）；负荷剂量5mL，速度2mL／h，单次给药0．5mL，锁定时间15min。观察患者术后疼痛视觉模拟评分（VAS）、不良反应以及Ramsay评分。结果：4组患者术后4hVAS评分差异无统计学意义（P〉0．05），S2，M组术后8h，16h评分低于S1组（P〈0．05），S2，M组镇痛满意率更高（P〈0．05）。M组恶心、呕吐、瘙痒发生率高（P〈0．05）。结论：舒芬太尼0．75μg／mL复合甲磺酸罗哌卡因0．237mg／kg用于子宫切除术后镇痛效果满意，不良反应发生率低。

The study on postoperative epidural analgesia effect with sulfentanil and fentanil or morphine add to ropivacaine mesylate after abdominal total hysterectomy

Objective：To eompare the analgesic and side effects of sufentanil,fentanil or morphine add to ropivacaine rnesylate contiuous infusion epidural analgesia after abdominal total hysterectomy. Methods ：One hundred twenty patients,ASA Ⅰ or Ⅱ ,undergoing elective abdominal total hysterectomy cesarean,were randomly divided into four groups . PCEA solution contained 0. 2 3 7 mg / mL ropivaeaine mesylate plus sufentanil 0. 5 , 0. 7 5μg / mL , fentanil 5 μg/mL or morphine 0. 06 mg/mL（groupS1,S2,F,M,n=30 each）. The PCEA was set up to deliver a 0. 5 mL bolus dose with a 15 min lockout interval and background infusion at 2 mL/h after a loading dose 5 mL. The VAS score, Ramsay sedation score ,and side effects were record. Results ：The VAS score was significantly higher in group S1 than group S2 and M during the 8 h, 16 h after operation. There were more satisfied for postoperative analgesia in group M and S2. More severe nausea,vomiting and pruritus were recorded in group M. Conelusion：PCEA with 0. 237% ropivacaine mesylate plus sufentanil 0. 75μg/mL provides satisfied analgesia after abdominal total hysterectomy.