舒芬太尼用于骨科老年患者硬膜外自控镇痛的临床观察

目的比较老年骨科病人术后自控镇痛采用不同剂量的舒芬太尼复合0.125%布比卡因持续硬膜外输的临床安全性及有效性。方法将60例老年骨科手术患者,随机分为3组(n=20),分别为A组:舒芬太尼2.5μg/kg;B组:舒芬太尼2.0μg/kg;C组:1.5μg/kg,均复合0.125%布比卡因和2.5 mg氟哌利多,总量100 ml药液注入镇痛泵,术毕连接镇痛泵行硬膜外镇痛,以2 ml/h的速度持续输注。采用双盲对照法,比较三组患者术毕及术后2 h、4 h、8 h、12h、24 h、48 h的视觉模拟(VAS)评分、镇静评分、运动阻滞评分及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生情况。结果观察病人术后48 h内评分,在各时间段:①VAS镇痛评分:C组与B、A相比都具有统计学差异(P<0.05),而B与A组相比只有在8 h和12 h有统计学差异﹙P<0.05﹚。②镇静评分:A组与B组、C组相比Ramsay镇静评分较高,且有统计学差异(P<0.05),而B组和C组只在8 h有统计学差异﹙P<0.05﹚。③C组皮肤瘙痒的发生率也高于A组、B组(P<0.05)。④3组病人的运动阻滞评分及恶心、呕吐、呼吸抑制等不良反应发生率均无统计学差异﹙P>0.05﹚。结论硬膜外连续输注2.0μg/kg舒芬太尼复合0.125%布比卡因及2.5 mg氟哌利多,用于骨科老年患者手术术后镇痛,效果良好,不良反应小,有利于患者的术后恢复,是一种较理想的镇痛方法。

The clinical observation of Sufentanil in epidural analgesia of geriatric orthopedic patients

Objective To compare the clinical effectiveness and the safety of postoperative continuous epidural analgesia with Sufentanil in different concentration combined with 0. 125% Bupivaeaine on pain of the geriatric orthopedic patients. Methods Sixty geriatric postoperative patients were divided into 3 groups with a randomized double - blind method. A group was applied with Sufentanil, 2.5 μg/kg; B group ： Sufen- tanil, 2.0 μg/kg; C group： Sufentanil, 1.5 μg/kg. All these patients were also given 0. 125% Bupivacaine and 2.5mg Droperidol. The total a- mount of 100 ml was injected using analgesia pump. The analgesia pump was used to inject continually the analgesic into epidural space with the speed of 2mlfh. A controlled double - blind study would be taken at immediate, 2, 4, 8, 12, 24, and 48 h after operation for the VAS score, Ramsay sedation score, Bromage motor blocking score, vomiting, pruritus, and respiratory depression, ere adverse reaction. Resulls The score of these patients was compared in different time after operation. （1）There was statistical difference （ P 〈 0. 05 ） between C and B, A in VAS score in all time. But there was statistical difference （ P 〈0.05） between B and A in VAS score in 8 h and 12 h. （2） There was statistical difference （ P 〈 0. 05 ） between C and B, A in Ramsay sedation score. The Ramsay score of A group is higher than that of B and C group. There was statistical difference in Ramsay score at 8h of B and C group. （3） The incidence rate of pruritus in C group is higher than A and B. There was statistical difference in this index（ P 〈 0. 05 ）. （4） There was no statistical difference （ P 〉 0.05 ） in Bromage motor blocking score, adverse reaction of nausea, vomiting, and respiratory depression among A, B, and C group （ P 〉 0. 05 ）. Conclusion The application of 2.0 μg/kg Sufentanil in- jected continually into epidural space combined with 0. 125% Bupivacaine and 2.5mg Droperidol to the postoperative analgesia of geriatric orthope- dic surgical patients is an ideal method with good effect, few adverse reactions. This method is an ideal application for recovery after operation.