低浓度甲磺酸罗哌卡因复合舒芬太尼硬膜外镇痛的观察

目的比较等效剂量苏芬太尼低浓度甲磺酸罗哌卡因和芬太尼复合布比卡因用于开胸术后患者自控硬膜外镇痛（PCEA）的效果及不良反应。方法选择全麻下开胸手术患者60例,随机分为芬太尼镇痛组（F组,n=30）和苏芬太尼镇痛组（SF组,n=30）。检测术后24h和48h患者血浆中的去甲肾上腺素（NE）水平,记录脉搏,血氧饱和度,心率,呼吸频率和平均动脉压,并判定疼痛,镇静,恶心和呕吐评分。结果S组术后24h,48h血浆NE水平及疼痛评分均低于F组（P〈0.05）,术后24h镇静评分和术后48h恶心呕吐评分均优于F组（P〈0.05）。与S组相比,F组术后24h恶心呕吐评分,48h镇静评分,脉搏,血氧饱和度,心率,呼吸频率和平均动脉压均无显著差异（P〉0.05）。结论与等效剂量芬太尼相比,苏芬太尼复合低浓度甲磺酸罗哌卡因用于开胸术后PCEA的镇痛镇静效果好,恶心呕吐发生率低,且血浆去甲肾上腺素浓度降低,是开胸术后更安全有效的镇痛方法。

A comparative study of patient-controlled epidural analgesia with sufentanil and fentanyl after thoracotomy

Objective To evaluate the efficacy of sufentanil and fentanyl at equivalent dose for patientcontrolled epidural analgesia （ PCEA ） after thoraeotomy. Methods Sixty Cases undergoing radical operation were randomly divided into sufentanil intravenous analgesia group （ Group SF, n = 30 ） and fentanyl intravenous analgesia group（ Group F, n = 30）. At 24 h and 48 h after operation, NE concentration in plasma was detected. The pain intensity, sedative scores and nausea scores were evaluated and the saturation of oxygen（ SaO2 ）, respiratory rate （RR） , mean artery blood pressure （MAP）were recorded. Results Compared with Group F, the plasma NE concentration and the pain intensity were lower（ P 〈 0.05 ）and the sedative efficacy was better in group SF（ P 〈 0.05 ） , while the incidence of nausea and vomiting in group SF was lower than that in group F（ P 〈 0. 05 ）. No significant differences were observed in SaO2 , RR, heart rate and mean arterial pressure between the two groups. Conclusion PCEA with sufentanil provides a better efficacy of analgesia and sedation but a lower incidence of nausea and vomiting than fentanyl for postoperative patients.