不同舒芬太尼效应室浓度联合舒芬太尼术后镇痛的效果比较

目的比较舒芬太尼靶控输注时不同效应室浓度联合舒芬太尼术后静脉自控镇痛的效果。方法选择拟行开胸手术的患者150例，随机分为3组。所有患者均使用丙泊酚和舒芬太尼靶控输注行全凭静脉麻醉。术毕均使用舒芬太尼行静脉自控镇痛。I、Ⅱ、Ⅲ组分别选择舒芬太尼效应室浓度为0．10ng／mL、0．12ng／mL、0．15ng／mL时使用镇痛泵。监测并记录麻醉诱导前（T0）、手术开始30min后（T1）、手术结束时（T2）、拔除气管导管后5min（T3）及术后60min（T4）的心率、平均动脉压。记录苏醒时间、自主呼吸恢复时间及拔管时间。评价拔除气管导管后5min（T3）及术后60min（T4）的视觉模拟疼痛评分、Ramsay镇静评分。记录术后60min内患者自控镇痛按压次数及嗜睡、呼吸抑制、烦躁等不良反应发生率。结果I组在T3、T4时点HR、MAP明显高于Ⅱ组、Ⅲ组（P〈0．05）。Ⅲ组的自主呼吸恢复时间、苏醒时间、拔管时间较I组、Ⅱ组延长（P〈0．05）。Ⅱ组、Ⅲ组拔除气管导管后5min及术后60min的视觉模拟（vas）疼痛评分优于I组（P〈0．05）。II组拔除气管导管后5min及术后60min的Ramsay镇静评分优于I组、Ⅲ组（P〈0．05）。11组、Ⅲ组患者术后60min内自控镇痛按压次数低于I组（P〈0．05）。11组术后60min内嗜睡、呼吸抑制（呼吸〈8次/min）、烦躁等不良反应发生率低于I组、Ⅲ组（P〈0．05）。结论舒芬太尼效应室靶浓度为0．12ng／mL时行舒芬太尼患者静脉自控术后镇痛最安全有效，不良反应最少。

Comparison of Different Effect Compartment Concentration of Sufentanil Combined with Patient-controlled Intrave- nous Analgesia.

Objective To compare the effects of different effect compartment concentration of sufentanil combined with postoperative patient-controlled intravenous analgesia. Methods One hundred and fifty patients scheduled for thoracic surgery were randomly divided into three groups. Anesthesia was induced and maintained in all patients using target controlled infusion of sufentanil and propofol. All patients treated with patient-controlled intravenous analgesia （PCIA） with sufentanil after the opera- tion. Group I , group II and group HI received PCIA at effect compartment concentration of 0. 10ng/ml, 0. 12ng/ml and 0. 15ng/ml, respectively. Mean arterial pressure （ MAP）, heart rate （HR） of three groups before induction of anesthesia （ To ）, at 30 min after the beginning of surgery （T1 ）, at the end of surgery （T2）, at 5min after extubation （T3） and 60 min after the end of surgery （T4） were monitored. The time of recovery, spontaneous breathing and extubation were all recorded. The visual analog scale（VAS） of postoperative pain and the Ramsay scale at the time of 5min after extubation and 60min after operation were assessed in three groups. In 60 rain after extubation, pressing times of PCIA pump and the incidence of somnolence, respiratory depression and delirium were recorded. Results At T3 and T4 , the MAP and HR in group I were higher than group II and III （P 〈 0.05 ） o The time of recovery, spontaneous breathing and extubation in group m were longer than group I and II （ P 〈 0. 05） o The VAS of II and III at T3 and T4 were better than group I （P 〈0. 05） . The Ramsay score at T3 and T4 of group U were better than I and III （ P 〈 0. 05 ） o In 60 min after extubation, pressing times of PCIA pump and the incidence of postopera- tive complications were higher than I and II1 （ P 〈 0. 05 ）. Conclusion It is the most suitable to receive PCIA when effect com- partment concentration of sufentanil is at 0. 12ng/ml, which is the safest, most effective and cause less side effects.