舒芬太尼复合罗哌卡因用于下肢手术硬膜外自控镇痛的剂量优化

目的 探讨舒芬太尼复合罗哌卡因用于下肢手术后患者硬膜外自控镇病(PCEA)的临床效果.方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行下肢手术的90例患者,随机分为三组,每组30例.分别应用0.2 μg/mL舒芬太尼、0.125％罗哌卡因(A组),0.4 μg/mL舒芬太尼、0.125％罗哌卡因(B组),0.6 μg/mL舒芬太尼、0.125％罗哌卡因(C组).行术后PCEA,即负荷剂量(5mL)、持续剂量(3 mL/h)、患者自控镇痛(PCA)剂量(每次1 mL),锁定时间20 min.分别于术后4、8、20、24、48 h观察三组各时间点镇痛药的用量、PCA的实际按压次数及有效按压次数、视觉模拟评分(VAS)、生命体征以及恶心、呕吐、头晕、嗜睡、呼吸抑制和皮肤瘙痒等不良反应的发生情况.结果 三组患者总体镇痛效果满意,生命体征稳定.术后各时间点VAS、镇痛药消耗量、PCA实际按压次数B、C组与A组比较,差异有统计学意义(P＜0.05),B组与C组比较,差异无统计学意义(P＞0.05).24h内不良反应中恶心、瘙痒的发生率随舒芬太尼浓度的增大而增多,其中C组与B、A组比较,差异有统计学意义(P＜0.05),B组与A组比较,差异无统计学意义(P＞0.05).三组患者呕吐、运动阻滞、嗜睡比较,差异无统计学意义(P＞0.05),未发生呼吸抑制.结论0.4 μg/mL舒芬太尼复合0.125％罗哌卡因用于下肢手术后患者行PCEA,镇痛效果明确,不良反应发生率低,可为患者提供安全、满意的术后镇痛.

Dose optimization of sufentanil combined with ropivacaine for postoperative controlled epidural analgesia in patients with lower limb surgery

Objective To explore the clinical effects of sufentanil combined with ropivacaine for postoperative controlled epidural analgesia(PCEA) in the patient with lower limb surgery.Methods 90 cases(ASAⅠ-Ⅱ) scheduled for the lower limb surgery were randomly divided into three groups,30 cases in each group.Sufentanil 0.2 μg/mL and 0.125% ropivacaine were given in the group A,sufentanil 0.4 μg/mL combined with 0.125% ropivacaine in the group B and sufentanil 0.6 μg/mL combined with 0.125% ropivacaine in the group C,respectively.Postoperative PCEA were performed through loading dose(5 mL) + continuous dose(3 mL/h)+ patient controlled analgesia(PCA) dose(1 mL/times).The analgesia effects were evaluated postoperatively by the Visual Analogue Scales(VAS),the use amount of analgesic drug and the requirements of PCA among 3 groups.The incidences of adverse reactions were evaluated,such as nausea,vomiting,itching,motor block,drowsiness,respiratory depression in the period of postoperative 0-48 h.Results All the patients showed good pain relief.The analgesic VAS scores,the dose of drug,the requirements of PCA at various postoperative timepoints were decreased with sufentanil concentration increasing.The difference between the group B and C with the group A had statistic significance(P<0.05).The difference between the group B and C had no statistic significance(P>0.05).The incidence rates of adverse reactions within 24 h in nausea and pruritus were increased with sufentanil concentration increasesing.The defference between the group C with the group B and A had statistic significance(P<0.05).The difference between the group B and A had no statistical significance(P>0.05).The incidence rate of vomiting,motor block and lethargy had no statistical difference(P>0.05) among the three groups.No respiratory depression happened.Conclusion Sufentanil 0.4 μg/mL combined with 0.125% ropivacaine can get better analgesic effect with less adverse reactions for PCEA in the patients with lower limb surgery and provides safe and satisfactory postopertative analgesia for the patients.