不同节段硬膜外舒芬太尼用于上腹部手术后镇痛的研究

目的探讨腰部硬膜外舒芬太尼镇痛在上腹部手术中应用的可行性及有效性。方法择期或限期行上腹部大手术的病人54例,随机分为高位组（H组）,中位组（M组）,低位组（L组）,每组各18例。均于术毕前30min硬膜外腔给予镇痛负荷剂量0.2μg/kg舒芬太尼5ml。术毕3组患者均经硬膜外接镇痛泵输注1.5μg/ml舒芬太尼,行病人自控硬膜外镇痛（PCEA）,观察并比较3组的镇痛效果及其不良反应。结果 3组术后VAS比较H组与M组静息和咳嗽时的疼痛VAS评分比较差异无统计学意义（P〉0.05）,术后2、4h时L组的静息时VAS评分均显著高于H组与M组（P〈0.05）,3组静息VAS评分8、20、24、30、48h比较差异无统计学意义（P〉0.05）;L组咳嗽时VAS评分术后2、4、8h均显著高于H组与M组（P〈0.05）,3组咳嗽VAS评分20、24、30、48h比较差异无统计学意义（P〉0.05）。3组术后瘙痒发生率、恶心发生率差异无统计学意义（P〉0.05）;3组术后各时点均未发生呼吸抑制;H组、M组分别与L组在术后第1天舒芬太尼累积用量两两组间比较差异均有统计学意义（P〈0.05）;第2天舒芬太尼的用量比较差异无统计学意义（P〉0.05）。H组、M组分别与L组在术后48h镇痛泵按压总次数和总有效次数两两组间比较差异均有统计学意义（P〈0.05）。结论胸段硬膜外输注1.5μg/ml舒芬太尼可用于上腹部手术术后疼痛治疗,镇痛效果良好,不良反应少;作为上腹部手术后镇痛的方法,1.5μg/ml舒芬太尼腰部硬膜外输注可替代胸部硬膜外输注,但舒芬太尼用量比胸段时偏大。

A Study of Epidural Analgesia Using Sufentanil at Different Puncture after Upper Abdominal Surgery

Objective To evaluate the efficacy and feasibility of clinical application of Sufentanil in lumbar epidural analgesia.Methods 54 patients were arranged for elective or limited upper abdominal major operations and they were randomly divided into 3 groups according to the epidural puncturing site of the high level,median level and low level.Postoperative analgesic effects,patient controlled epidural analgesia（PCEA） pump usage,drug consumption and side effects were observed within 48 h.Results There were no differences in VAS scores of the patients at resting or coughing between Group H and Group M（P0.05）.At 2 and 4 h after operation,the resting VAS score in Group L was significantly higher than that in Group H and Group M（P 0.05）.At 8,20,24,30 and 48 h after operation,there were no significant differences of resting VAS score among the 3 groups（P0.05）.At 2,4 and 8 h after operation,the VAS score at coughing condition in Group L was significantly higher than that in Group H and Group M（P 0.05）.Afterwards,there was no significant difference among the 3 groups（P0.05）.Nausea was observed in 3 patients in each group within 48 h after operation and there were no significant differences（P0.05）.Similarly,the incidences of itching among the 3 groups were not statistically significant（P0.05）.No respiratory depression at any time point after operation in the 3 groups was observed.The difference in the cumulative consumption of Sufentanil at day-1 after operation between Group H,Group M and Group L was significant（P0.05）.However,there were no significant differences in the consumption of Sufentanil in these 3 groups at the second day（P0.05）.The differences in the total pump pressing times and total effecting times within 48 hours after operation between Group H,Group M and Group L were statistical significant（P0.05）.Conclusion 1.5 μg /ml epidural Sufentanil pumped into the thoracic intervertebral spaces can be applied into the pain treatment after upper abdominal operation.The analgesic effect is satisfactory with little adverse effects.1.5 μg /ml epidural Sufentanil pumped into the lumbar intervertebral spaces can substitute for thoracic epidural analgesia as an alternative method in the pain treatment after upper abdominal operation.However,compared to the latter,the Sufentanil dosage is relatively high.