舒芬太尼用于老年患者瑞芬太尼麻醉后镇痛的剂量探析

目的]探讨舒芬太尼在进行胸腹大手术的老年患者使用瑞芬太尼麻醉之后达到适宜镇痛效果的最佳剂量.方法]将60例择期行胸腹大手术的老年患者随机平均分为4组各15例,分别于停用瑞芬太尼后静脉注射舒芬太尼0.025 μg/kg（A组）、0.035 μg/kg（B组）、0.045 μg/kg （C组）和0.065 μg/kg（D组）.评估4组患者在静脉镇痛后20 min（T1）、40 min（T2）、80 min（T3）、120 min（T4）4个时间点的镇痛及镇静效果,需要加注镇痛药物的例数及各组患者出现的不良反应等等.结果]与A组比较,B、C、D组患者在40 min和80 min时镇痛效果明显增强,视觉模拟评分法（VAS）评分显著降低（P〈0.01）,并且要求加注镇痛药物的例数也少于A组（P〈0.05）.A组患者在T1时镇静效果较B、C组差,Ramsay评分显著降低（P〈0.01）,D组患者在T1时镇静效果较B、C好,Ramsay评分显著增加（P〈0.01）.与A,B,C组相比,D组患者有明显的呼吸抑制,延迟拔管时间及术后清醒时间.B组及C均能取到极为满意的镇痛镇静效果,而B组浓度较小,呼吸抑制等不良反应更少.结论]舒芬太尼可作为经受胸腹大手术的老年患者瑞芬太尼麻醉后镇痛的理想静脉用药,推荐最佳剂量为0.035μg/kg.

Study on the Dose of Sufentanil for Analgesia on Elderly Patients after Remifentanil-based Anesthesia

Objective] To explore the optimal dose of sufentanil for analgesia on elderly patients after remifentanil-based anesthesia. Methods] Sixty elderly patients scheduled for thoracic or abdominal surgery were randomly divided into four groups averagely. After the withdrawal of remifentanil, sufentanil 0. 025μg/ kg（group A）, 0. 035μg/kg（group B）, 0. 045μg/kg（group C） and 0. 065μg/kg（group D） were intravenously injected into each group, respectively. The analgesia and sedation effects of patients in four groups at 20min （T1）, 40min（T2 ）, 80rain（T3 ） and 120min（T4 ） after venous analgesia were evaluated. The number of patients who needed the injection with additional analgesics and the adverse reaction in each group were observed. IRe- suits] Compared with group A, the analgesic effects of group B, C and D were evidently increased, and the visual analog score（VAS） was evidently decreased（ P 〈0.05）. The number of patients who required the injection of additional analgesics in group B, C and D was less than that in group A（ P d0.05）. The sedative effect of group A at T1 was poorer than that in group B and C, and Ramsay score in group A at Ta obviously decreased（ P d0.01）. The sedative effect of group D at T1 was better than that in group B and C, and Ramsay score in group D at T1 obviously increased（ P 〈0.01）. Compared with group A, B and C, group D had obvious respiratory depression and the delay of extubation time and postoperative awake time. Both group B and C could obtain satisfactory analgesic and sedative effect, but the dose in group B was smaller and adverse reactions such as respiratory depression were fewer. Conclusion] Sufentanil can be an ideal intravenous analgesic drug for elderly patients who undergo thoracic or abdominal surgery after remifentanil-based anesthesia. The optimal does is 0. 035/μg/kg.