体重指数对腹腔镜下妇科手术后舒芬太尼镇痛效果的影响

目的探讨不同体重指数(BMI)对使用舒芬太尼术后镇痛效果的影响。方法纳入我院2018年1~12月行腹腔镜下妇科手术后采用舒芬太尼镇痛的患者174例,根据BMI的不同将其分为3组:BMI<18.5 kg/m 2为偏瘦组,BMI 18.5~23.9 kg/m 2为正常体重组,BMI 24~27.9 kg/m 2为超重组,每组58例。所有患者均采用舒芬太尼静脉自控镇痛(PCIA),配方为舒芬太尼2μg/kg+格拉司琼6 mg+生理盐水,总量为200 mL。比较分析术后各组患者疼痛NRS评分、镇痛泵按压次数、平均动脉压(MAP)、心率(HR)及不良反应发生情况[镇静状态评分≥1分,恶心、呕吐、瘙痒NRS评分>3分,呼吸抑制(呼吸频率≤8次/分钟或SpO2<90%)]。结果正常体重组和超重组术后6 h NRS评分均低于偏瘦组,差异具有统计学意义(P<0.05),正常体重组和超重组间比较差异无统计学意义(P>0.05);正常体重组和超重组患者术后6、24 h镇痛泵的按压次数均少于偏瘦组,差异有统计学意义(P<0.05)。术后3组患者恶心、呕吐、镇静状态、瘙痒及呼吸抑制发生率比较差异无统计学意义(P>0.05)。术后3组患者MAP及HR比较差异无统计学意义(P>0.05)。结论BMI是影响舒芬太尼术后镇痛效果的因素之一。

Effect of BMI on postoperative analgesia effect of sufentanil for patients after laparoscopic gynecological surgery

Objective To analyze the postoperative analgesia effect of sufentanil for patients with different body mass index(BMI)after laparoscopic gynecological surgery.Methods Retrospectively analyzed the postoperative analgesia effect of sufentanil among 174 patients who underwent laparoscopic gynecological surgery in our hospital from January to December 2018.All the patients were divided into 3 groups according to BMI,with 58 cases in each group.Patients whose BMI were less than or equal to 18.5 kg/m 2 were classified as member of the underweight group;patients whose BMI ranged from 18.6 to 23.9 kg/m 2 were classified as member of the normal weight group;and patients whose BMI ranged from 24 to 27.9 kg/m 2 were classified as member of the pre-obese group.All the patients were treated with sufentanil for patient-controlled intravenous analgesia(PCIA),with the formula(200 mL in total)of sufentanil(2μg/kg),granisetron(6 mg)and saline.Postoperative pain NRS score,press numbers of the analgesic pump,mean arterial pressure(MAP),heart rate(HR),and adverse reactions[sedation score more than or equal to 1 point,nausea,vomiting,pruritus NRS score more than 3 points,and respiratory depression(respiratory rate less than or equal to 8 times/min or SpO 2 less than 90%)]were compared and analyzed among the three groups.Results Compared with the underweight group,NRS score at 6 hours after treatment in the normal weight group and the pre-obese group were lower,with statistically significant difference(P<0.05),and the differences between the normal weight group and the pre-obese group was not statistically significant(P>0.05).The press numbers of the analgesic pump at 6 and 24 hours after treatment in the normal weight group and the pre-obese group were less than that of the underweight group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of nausea,vomiting,sedation,pruritus and respiratory depression among the three groups(P>0.05).There was no significant difference in MAP and HR between the three groups(P>0.05).Conclusion BMI is one of the important factors on the postoperative analgesia effect of sufentanil.