利多卡因联合舒芬太尼用于老年患者腰椎减压内固定术后静脉自控镇痛的效果

目的：观察利多卡因联合舒芬太尼用于老年患者腰椎减压内固定术后静脉自控镇痛（PCIA）的效果。方法选择择期行腰椎减压内固定术的老年患者60例，美国麻醉医师协会分级Ⅰ～Ⅱ级，均采用静脉诱导静吸复合全身麻醉，随机数字表法分为两组（n=30）：利多卡因＋舒芬太尼（L＋SF）组和舒芬太尼（SF）组。 L＋SF组于术后给利多卡因针50 mg/kg和舒芬太尼针150μg，SF组于术后给舒芬太尼针150μg，两组均用0.9％氯化钠注射液稀释到300 ml， PCIA以LCP模式（负荷量4.0 ml＋持续量4.0 ml/h＋单次病人自控镇痛（PCA）量4.0 ml/次）给药，PCA均间隔20 min，术后48 h停用镇痛泵。结果两组在各时点的视觉模拟评分（VAS）相当，差异均无统计学意义（t分别=0.23、0.46、0.22、0.33、0.26、0.41、0.22、0.17、0.07、0.61、1.11、1.10，P均＞0.05）；L＋SF组术后24 h、48 h 的PCIA按压次数和有效按压次数明显低于SF组，差异均有统计学意义（t分别=2.78、3.00、3.78、4.63，P均＜0.05）；L＋SF组术后24 h、48 h内舒芬太尼的用量明显低于SF组，差异均有统计学意义（t分别=5.51、6.75，P均＜0.05）；术后L＋SF组的呼吸抑制发生率和过度镇静发生率明显低于SF组，差异均有统计学意义（χ2分别=5.46、4.32，P均＜0.05）；两组恶心、呕吐的发生率比较，差异均无统计学意义（χ2分别=1.93、2.03， P均＞0.05）。结论利多卡因联合舒芬太尼可以安全用于老年患者腰椎减压内固定术后静脉自控镇痛，镇痛效果较好，不良反应发生率低。

Patient-controlled intravenous analgesia effect of lidocaine combined sufentanil on decompression and inter fixa-tion surgery of lumbar vertebra in elderly patients

Objective To investigate the patient-controlled intravenous analgesia （PCIA） effect of lidocaine combined sufentanil on decompression and inter fixation surgery of lumbar vertebra in elderly patients. Methods Sixty elderly pa-tients with ASA I~II whose general anesthesia induced by intravenous inhalation and underwent decompression and inter fixation surgery of lumbar vertebra were randomized into two groups： lidocaine combined sufentanil （L＋SF） group and sufentanil （SF） group. The L＋SF group was given lidocaine 50 mg/kg and SF 150μg that were diluted into 300 ml 0.9%sodium chloride injection. The SF group was given SF 150μg that was diluted into 300 ml 0.9%sodium chloride injection. Postoperative analgesia was provided by PCA pump at an interval of 20 min with LCP model which included load dosage 4.0ml, lasting dosage 4.0 ml/h and 4.0 ml per time. PCA pump was stopped at 48 hours after surgery. Results There were no significant differences in the visual analogue score between two groups at different time points （t=0.23, 0.46, 0.22, 0.33, 0.26, 0.41, 0.22, 0.17, 0.07, 0.61, 1.11, 1.10, P〉0.05）. Compared with SF group, the pressing times and ef-fective pressing times at 24 hours and 48 hours of L＋SF group were significantly lower （t=2.78, 3.00, 3.78, 4.63, P〈0.05）. The volume dose of sufentanil at 24 hours and 48 hours of L＋SF group were significantly lower than that of SF group （t=5.51, 6.75,P〈0.05）. The respiratory depression incidence and excessive sedation incidence of L＋SF group were sig-nificantly lower than those of SF group （χ2=5.46, 4.32, P〈0.05）. However, the nausea and vomiting incidence between two groups had no statistical significantly differences （χ2=1.93, 2.03, P〉0.05）. Conclusions Lidocaine combined with sufentanil is safe in PCIA that undergo the decompression and inter fixation surgery of lumbar vertebra. The effect of lido-caine combined sufentanil in PCIA on decompression and inter fixation of lumbar vertebra surgery was effec-tive with