舒芬太尼皮下镇痛用于腹部手术的临床观察

目的探讨不同剂量舒芬太尼用于患者自控皮下镇痛（PCSA）在腹部手术后镇痛效果的安全性和有效性。方法腹部手术患者45例术毕分三组,A组间歇按需肌注杜非合剂镇痛;B组舒芬太尼3.0μg/kg＋2%盐酸利多卡因200 mg＋生理盐水至100 ml;C组舒芬太尼3.5μg/kg＋2%盐酸利多卡因200 mg＋生理盐水总量100 ml。B、C组行PCSA并于术后3、8、24、48及72 h观察,并比较休息、咳嗽时的疼痛视觉模拟（VASr/VASc）评分及Ramsay评分、肛门排气时间、总体满意度评分;生命体征：SBP、DBP、HR、SPO2;并发症：呼吸抑制、恶心呕吐、皮肤瘙痒的发生率。结果 VAS（休息/咳嗽）评分在术后72小时C组显著低于A和B组（P〈0.05）;术后镇痛生命体征平稳,Ramsay评分、肛门排气时间、呼吸抑制、恶心呕吐、皮肤瘙痒发生率组间比较差异无统计学意义（P〉0.05）;总体镇痛满意度评分C组显著高于A和B组（P〈0.05）。结论 3.5μg/kg舒芬太尼PCSA在腹部手术后镇痛效果确切,副反应少且对胃肠功能的恢复影响小。

Clinical observation of sufentanil for subcutaneous analgesia underwent abdominal surgery

Objective To evaluate the safety and efficacy of several different dosages of sufentanil for patient-controlled subcutaneous analgesia after abdominal surgery.Methods 45 patients with ASAⅠorⅡundergoing abdominal surgery were allocated into 3 groups.According to demanding for musle-inject misture Pethidine and Promethazine in A groups,B groups were received PCSA with sufentanil 3.0μg/kg diluted with normal saline 100ml and C groups were received PCSA with sufentanil 3.5μg/kg diluted with normal saline 100ml.VASr and VASc were used to assess analgesia at rest and cough at 3,8,24,48 and 72h after surgery.The observer＇s assessment of Ramsay scores,anal exhaust time,total satisfaction scores,vital signs including SBP,DBP,HR,SPO2 and side effects（respiratory depression,nausea,vomiting and pruritus） were recorded.Results During the 8 to 72 hours after abdominal surgery,the VASr and VASc scores in groups C were significantly lower than those in groups A and B（P0.05）.The vital signs were stable.Ramsay scores,anal exhaust time and the incidence of side-effects was not significantly different（P0.05）.Total satisfaction scores in groups C were significantly higher than those in groups A and B（P0.05）.Conclusion It is effective for abdominal surgery with 3.5μg/kg sufentanil.