子宫切除术后不同浓度舒芬太尼混合左旋布比卡因病人硬膜外自控镇痛的效果  

Efficacy of patient-controlled epidural analgesia with different concentrations of sufentanil added to levobupivacaine after abdominal total hysterectomy

作　　者：何莉[1] 佘守章[1] 谢晓青[1] 

机构地区：[1]广州医学院附属广州市第一人民医院麻醉科,510180

出　　处：《中华麻醉学杂志》2007年第2期173-176,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价不同浓度舒芬太尼与左旋布比卡因混合用于经腹子宫切除术后病人硬膜外自控镇痛（PCEA）的效果。方法 择期经腹行子宫切除术病人90例，年龄41～64岁，ASAⅠ或Ⅱ级，随机分为3组（n=30）：Ⅰ组（舒芬太尼0．4μg／ml配伍0．2％左旋布比卡因）、Ⅱ组（舒芬太尼0．5μg／ml配伍0．2％左旋布比卡因）、Ⅲ组（舒芬太尼0．6μg／ml配伍0．2％左旋布比卡因）。均采用LCP模式给药，负荷剂量5ml，持续剂量1ml／h，单次给药剂量2ml，锁定时间10min，全程镇痛24h。观察和记录病人PCA泵开启时和开启后4、8、16、20、24hMAP、HR、视觉模拟法（VAS）评分、Ramsay评分、总按压次数／实际有效进药次数（D1／D2）比值及术后恶心、呕吐等不良反应发生情况。结果 与Ⅰ组比较，Ⅱ组、Ⅲ组PCA泵开启后8、12hVAS评分降低（P〈0．05）；3组术后镇痛期间未按压的例数Ⅰ组最少，Ⅲ组最多（P〈0．05）；3组按压次数〉9次的例数Ⅲ组最少（P〈0．05）；D1／D2比值Ⅰ组高于Ⅱ组、Ⅲ组。Ⅰ组有4例需硬膜外追加吗啡，Ⅰ组发生低血压1例，Ⅱ组发生头晕1例。3组均未发生恶心、呕吐、呼吸抑制等不良反应。结论 舒芬太尼0．6μg/ml与0．2％左旋布比卡因混合用于经腹子宫切除术后PCEA效果满意，且不良反应发生率低。Objective To evaluate the efficacy of patient-controlled epidural analgesia （PCEA） with different concentrations of sufentanil added to levobupivacaine after abdominal total hysterectomy. Methods Ninety ASA Ⅰ or Ⅱ patients aged 41-64 yrs with body weight index 〈 30 kg/m^2 undergoing elective abdominal total hysterectomy under epidural anesthesia received PCEA for 24 h after operation. Epidural catheter was placed at T11-12. The PCEA solution contained 0.2 % levobupivacaiue plus sufentanil 0.4, 0.5 or 0.6 μg· ml^-1 （group Ⅰ , Ⅱ , Ⅲ , n = 30 each）. The epidural PCA device was set up to deliver a 2 ml bolus dose with a 10-min lockout interval and background infusion at 1ml· h^- 1 after a loading dose of 5 ml. The VAS score, Ramsay sedation score, the ratio between the total number of attempts （D1） and the number of successfully delivered doses （D2） （D1/D2）, BP, HR, RR, SpO2 and side effects were recorded. Results The total amount of sufentanil administered via PCEA device during the 24 h after operation was 27± 6, 31 ± 5 and （38 ± 6）μg. The difference was statistically significant. The number of patients who did not demand any bolus dose after loading dose during 24 h after operation was smallest in group Ⅰ and largest in group Ⅲ. The number of patients who demanded more than 9 bolus doses was significantly smaller in groupⅢ than in group Ⅰ and Ⅱ. The D1/D2 ratio was significantly higher in group Ⅰ than in group Ⅱ and Ⅲ （ P 〈 0.05）. There were 4 patients who needed additional morphine in group Ⅰ Conclusion PCEA with 0.2% levobupivacaine plus sufeutanil 0.6 μg/ml provides best analgesia after abdominal total hysterectomy.

关 键 词：舒芬太尼 布比卡因 镇痛 硬膜外 镇痛 病人控制 

分 类 号：R686[医药卫生—骨科学]