高龄患者下肢骨科手术时应用舒芬太尼硬膜外镇痛的可行性

目的比较不同浓度舒芬太尼复合罗哌卡因用于高龄患者下肢骨科手术硬膜外镇痛的镇痛效果及相关不良反应。方法高龄下肢骨科手术患者36例,随机双盲分为A、B、C组,术后硬膜外镇痛分别应用舒芬太尼复合0.2、0.3、0.4μg/mL0.125罗哌卡因。于手术后4、8、16、24、48h观察患者的模拟视觉评分(VAS)、舒适度评分(BCS)、Ramsay镇静评分、镇痛药使用剂量、低血压例数、追加量(5mL/次)及不良反应。结果随着舒芬太尼浓度的增加,VAS评分、累计追加量逐渐下降,术后4、8、16hA组VAS评分高于B组、C组(P<0.05或0.01),BCS评分低于B组、C组(P<0.01或0.05)。术后8、16h,A组的Ramsay评分低于B组、C组(P<0.05或0.01)。A组镇静、恶心呕吐及皮肤瘙痒发生率低于C组(P<0.05)。与A组、B组比较,C组低血压例数有增加的趋势。结论舒芬太尼复合罗哌卡因用于高龄患者术后硬膜外镇痛效果明确,不良反应发生率低。0.3μg/mL舒芬太尼与0.125罗哌卡因配伍在获得满意镇痛效果的同时,也增了舒适度,不良反应相对较少,更适合高龄患者应用。

Feasibility of sufentanil for epidural analgesia in lower limbs surgery of aged patients

Objective To evaluate the feasibility and adverse effects of sufentanil for epidural analgesia in lower limbs surgery of aged patients.Methods 36 ASA Ⅱ～Ⅲ patients were randomized into 3 groups.Sufentanil 0.2,0.3,0.4 μg/mL was used in A,B,C groups combined with 0.125% ropivacaine respectively.VAS,BCS,Ramsay sedation scale,dose of analgesia drugs,cases of low pressure patients,additional quantity and adverse effects were recorded at 4,8,16,24,48 h after surgery.Results With dose of sufentanil increased,VAS,the cumulative additional quantity gradually decreased.After operation,in group A,VAS was higher than that of group B and group C,however,BCS was less.Ramsay sedation scale of group B and group C were significantly higher than that of group A.The adverse effects rate in group A were significantly less than that in group C.Conclusion Sufentanil combined with ropivacaine by PCEA can offer favorable analgesic responses,and the side effects are mild,especially for the aged or weak patients.