舒芬太尼在上腹部手术后硬膜外镇痛中的应用

目的　探讨不同浓度的舒芬太尼用于上腹部手术后硬膜外镇痛的安全性。方法将6 0例ASAⅠ～Ⅱ级于硬膜外联合全麻下行上腹部手术的患者随机均分为4组,分别为0 .15 %罗哌卡因(R)组,0 .15 %罗哌卡因+0 .2 5mg/L舒芬太尼(S) ,即(R +0 .2 5S)组,0 .15 %罗哌卡因+0 .5mg/L舒芬太尼(R +0 .5S)组,0 .15 %罗哌卡因+0 .75mg/L舒芬太尼(R +0 .75S)组。术后接入镇痛泵行持续硬膜外镇痛,观察术后3,6 ,12 ,2 4hVAS评分及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果　R +0 .5S组和R +0 .75S组的患者VAS评分显著低于R组和R +0 .2 5S组(P <0 .0 5 ) ;各组间的瘙痒发生率有显著性差异(P <0 .0 5 ) ,镇静评分、恶心与呕吐发生率无显著性差异。6 0例患者均未发生呼吸抑制等严重并发症。结论　浓度不高于0 .75mg/L的舒芬太尼用于上腹部术后硬膜外镇痛是安全的。

Application of Sufentanil in epidural analgesia after upper abd ominal surgery

Objective It is to discuss the safety of different c oncentration Sufen tanil in epidural analgesia after upper abdominal surgery. Methods 60 patients w ith ASA I~II degree undergoing upper abdominal surgery under epidural anesthesia combined with general anesthesia were randomly divided into four groups. They w ere 0.15% Ropivacaine (R) group, 0 15% Ropivacaine 0.25 mg/L Sufentanil (R 0.25 S ) group, 0.15% Ropivacaine 0.5 mg/L Sufentanil (R 0.5S) group and 0.15% Ropivaca ine 0.75 mg/L Sufentanil (R 0.75S) group respectively. All the patients were con tinued to receive epidural analgesia with analgesic pump. The visual analog scal es (VAS) score after operation for 3, 6, 12 and 24 h and the untoward reaction s uch as nausea, emesis, itch of skin and respiratory depression were observed. Results The VAS scores in R 0.5S group and R 0.75S group were signif icantly lower than that in R group and R 0.25S group (P<0 05). There were significant dif feren ce on the pruritus incidence among the four groups (P<0.05), but there were no s ignificant difference on the incidences of sedation score, nausea and emesis. Al l the patients had no serious complication such as respiratory depression. Conclusion Epidural analgesia after upper abdominal surgery with Sufent anil of less t han 0.75 mg/L is safe.