舒芬太尼用于腹腔镜胆囊切除术后替代性镇痛的临床研究

目的评价舒芬太尼用于瑞芬太尼和丙泊酚静脉复合麻醉下腹腔镜胆囊切除术（LC）后替代性镇痛的临床效果和安全性。方法 ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者90例,随机分为3组,每组30例,分别于停用瑞芬太尼后静脉注射舒芬太尼0.1μg/kg（S1组）,舒芬太尼0.2μg/kg（S2组）和芬太尼0.5μg/kg（F组）。记录3组患者在静脉镇痛后15min（T1）、30min（T2）、1h（T3）、2h（T4）、4h（T5）等各时间点镇痛、镇静评分,需要再次镇痛的例数及各组可能出现的尿潴留、皮肤瘙痒、恶心、呕吐等不良反应。结果 S1、S2组在同一时间点上疼痛视觉模拟评分（VAS）差异无统计学意义（P〉0.05）,与F组对应值比较,S1、S2组患者在T3、T4时VAS评分显著降低（P〈0.05）,而且主动要求再次镇痛的例数也少于F组（P〈0.05）。S2组患者在T1时镇静评分（Ramsay）较S1、F组显著增加（P〈0.05）。结论静脉注射舒芬太尼可作为瑞芬太尼和丙泊酚静脉复合麻醉下LC术后替代性镇痛的有效方法 ,推荐剂量为0.1μg/kg。

Clinic study of sufentanil in postoperative replacement analgesia for patients with laparoscopic cholecystectomy

Objective To evaluate the efficacy and safety of sufentanil in postoperative replacement analgesia of remifentanil with propofol for total intravenous anesthesia for patients with laparoscopic cholecystectomy（LC）.Methods Ninety patients of ASA class I or Ⅱ scheduled for selective laparoscopic cholecystectomy were randomly allocated into three groups for receiving with sufentanil 0.1μg/kg（group S1,n=30）,sufentanil 0.2 μg/kg（group S2,n=30） and fentanyl 0.5μg/kg（group F,n=30） after stopping intravenous pumping remifentanil and propofol.Visual analogue scales（VAS）,Ramsay scales,the cases of analgesia again and side-effects including retention of urine,pruritus,nausea and emesis were assessed after 15min（T1）,30min（T2）,1h（T3）,2h（T4） and 4h（T5） of vicarious analgesia.Results There were no significant differences in VAS at one time between group S1 with that in group S2.VAS scores both in group S1 and group S2 at T3 and T4 were lower than that in group F（P0.05）.So did the cases of analgesia again（P0.05）.The Ramsay scores in group S2 was higher at T1 than that in group S1（P0.05）.Conclusion Sufentanil intravenous injection is suitable for postoperative replacement analgesia after remifentanil with propofol for total intravenous anesthesia for patients with laparoscopic cholecystectomy,and the dose of sufentanil 0.1 μg/kg can obtained a better vicarious analgesia.