老年患者腹部手术后舒芬太尼自控皮下镇痛的效果

目的 观察老年患者腹部手术后应用舒芬太尼自控皮下镇痛(patient controlled subcutaneous analgesia,PCSA)的效果. 方法 选择80例择期全麻下行腹部手术的老年患者,ASA分级Ⅰ～Ⅱ级,年龄65岁～80岁,体重43 kg～75 kg,按随机数字表法分成4组,A1组(舒芬太尼60μg),A2组(舒芬太尼80μg),A3组(舒芬太尼100斗g),B组(舒芬太尼80μg),每组20例.4组药物均用生理盐水稀释至100 ml用于术后镇痛,A1、A2和A3组采用PCSA的方式,B组采用自控静脉镇痛(patient controlled intravenous analgesia,PCIA)的方式,爱朋ZZB型镇痛泵设定为负荷量3 ml,背景剂量1 ml/h,患者自控镇痛(patient controlled analgesia,PCA)剂量1 ml,锁定时间15 min.观察术后2(T1)、4(T2)、8(T3)、16(T4)、24(T5)、48 h(T6)时的疼痛视觉模拟评分、Ramsay镇静评分、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2),记录术后48 h按压PCA泵总按压次数(D1)、实际有效进药次数(D2)及恶心呕吐等副作用的发生情况. 结果在T1～T3时点,A1组静息时VAS镇痛评分分别为(3.1±1.5)分、(3.2+1.7)分、(2.8±1.3)分,高于B组(117+0.9)分、(1.5+0.8)分、(1.6+0.9)分(P<0.05);咳嗽时VAS镇痛评分分别为(3.3+1.7)分、(3.7±1.5)分、(3.2±1.6)分,高于B组(2.2+1.0)分、(2.3±1.2)分、(2.1±0.9)分(P<0.05.在T3、T4时点,A3组Ramsay镇静评分分别为(3.0±0.7)分、(3.0±0.3)分,高于B组(2.1±0.3)分、(2.1±0.2)分(P<0.05).与B组比较,A1组在T1、T2时点MAP较高(P<0.05)、术后48 h D1和D2较高(p<0.05),A3组术后48 h恶心、呕吐发生率较高(p<0.05).结论 在施腹部手术的老年患者,应用0.8 m/L舒芬太尼进行PCSA安全有效,镇痛效果好且副作用少.

Efficacy of patient controlled subcutaneous analgesia with sufentanil after abdominal surgery in elderly patients

Objective To observe the efficacy of patient controlled subcutaneous analgesia (PCSA) with sufentanil after abdominal surgery in elderly patients. Methods Eighty patients, aged 65 -80 yr, weigheding 43 kg-75 kg, classified as ASA Ⅰ-Ⅱ,undergoing elective abdominal surgery were included in this study. Using a random number table, patients were randomly divided into four 4 groups (n=20 each) , A1 (sufentanil 60 μg), A2(sufentanil 80 μg), A3 (sufentanil 100 μg) and group B (sufentanil 80 μg). In the four groups, the drug was diluted 100 ml with 0.9% normal saline. A patient controlled subcutaneous analgesia mode was used in groups A1, A2 and A3, while a patient controlled intravenous analgesia (PCIA) mode was used in group B. AAPON-ZZB pump was set up with loading dose of 3 ml, background infusion of 1 ml/h, a bolus dose of 1 ml, and lockout interval of 15 min. The pain Visual Analogue Scale (VAS) score, Ramsay sedation score, MAP,HR, RR and SpO2 were recorded at 2(T1),4(T2),8(T3), 16(T4),24(T5) and 48 h (T6) after surgery. The number of deliveries (D1) and effective deliveries (D2), and the adverse effects related to analgesia treatment during a 48 h postoperative period were noted. Results The VAS score in the state of rest of group A, was significantly higher than group B[(3.1±1.5)vs(1.7±0.9) at T1, (3.2±1.7)vs(1.5±0.8) at T2, (2.8±1.3) vs(1.6±0.9) at T3,respectively](P<0.05);the VAS score in the state of cough of group A1 was significantly higher than group B[(3.3± 1.7) vs (2.2±1.0) at T1, (3.7±1.5) vs (2.3±1.2) at T2, (3.2±1.6) vs (2.1±0.9) at T3, respectively] (P<0.05). The Ramsay sedation score of group A3 was significantly higher than group B [(3.0±0.7) vs (2.1±0.3) at T3, (3.0±0.3) vs (2.1±0.2) at T4, respectively] (P<0.05). The MAP of group A1 was significantly higher than group B at T1,2 (P<0.05), the D1 and D2 of group A1 was significantly higher than group B (P<0.05). The incidence of nausea and vomiting was higher in group A3 compared to group B (P<0.05). Conclusion In elderly patients undergoing abdominal surgery, PCSA with 0.8 mg/L sufentanil was effective and safe, with good analgesic effect and low incidence of adverse effects.