伍用舒芬太尼在硬膜外术后自控镇痛中对全髋置换术患者血液流变学的影响  

Influence of sufentanial in postoperative patient controlled epidural analgesia in hemorheology after total hip replacement

作　　者：段立波[1] 王丽萍[1] 潘振祥[1] 

机构地区：[1]吉林大学第二医院麻醉科,吉林长春130041

出　　处：《吉林大学学报（医学版）》2007年第4期747-750,共4页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅社会发展项目资助课题(200505118)

摘　　要：目的：观察术后舒芬太尼硬膜外自控镇痛（PCEA）对全髋置换术患者的血液流变学的影响,探讨舒芬太尼硬膜外自控镇痛对全髋置换手术患者血栓形成的抑制作用。方法：ASAⅠ-Ⅱ级行择期全髋置换手术患者50例,随机分为PCEA组和对照组,每组25例,均行连续硬膜外麻醉。PCEA组手术结束后经硬膜外腔注入0.2%罗派卡因5mL后接PCEA泵,镇痛液配方用舒芬太尼0.4mg·L^-1＋0.2%罗哌卡因＋生理盐水至100mL;背景速度2mL·h^-1,PCA剂量0.5mL,锁定时间15min。对照组患者则视术后疼痛情况间断肌注哌替啶。观察术后1、12、24及48hVAS评分的数值及麻醉后1h、术毕、术后24h、48h血液流变学各项参数的数值。结果：①术后1、12、24、48hVAS评分PCEA组均显著低于对照组（P〈0.05）。②两组患者麻醉后1h及术毕时血浆粘度和纤维蛋白原均低于麻醉前（P〈0.05）;术后48h,PCEA组恢复至术前水平,对照组仍升高并显著高于PCEA组（P〈0.05）。两组患者麻醉后1h及术毕全血粘度切变率各值均低于麻醉前,PCEA组术后24、48h各值逐渐恢复至麻醉前水平;对照组则进行性升高,术后48h显著高于麻醉前水平（P〈0.05）,且高于PCEA组（P〈0.05）。结论：舒芬太尼在硬膜外自控镇痛中改善了全髋置换术患者术后血液流变学指标,可作为减少术后血栓性并发症发生的有效措施之一。Objective To investigate the influence of sufentanial in postoperative patient controlled epidural analgesia （PCEA） in hemorheology after total hip replacement and its inhibitory effect on thrombosis. Methods Fifty patients, ASA Ⅰ-Ⅲ, undergone total hip replacement were randomly divided into PCEA group （n=25） and control group （n=25）, and received continuous epidural anesthesia. After operation, 5 mL 0.2% ropivacaine was administered in PCEA group, and then PCEA pump was used, analgesia liquid included 0.4 mg·L^-1 sufentanial, 0.2% ropivacaine and saline. Petidine was administered intramuscuarly according to pain in control group. VAS scores 1, 12, 24 and 48 h after operation and changes of various parameters of hemorheology at diffenent time after anesthesia were observed. Results （1）The VAS scores 1, 12, 24, 48 h after operation were lower than those in control group （P〈0.05）. （2）The plasma viscolities and fibrinogen levels in two groups 1 h after anesthesia and at the end of operation were significantly lower than before anesthesia （P〈0.05） ; 48 h after operation, they were higher in control group than those in PCEA group （P〈0.05）. The viscosity shear rates of whole blood in two groups 1 h after anesthesia and at the end of operation were lower than before anesthesia （P 〈 0.05）.Conclusion Sufentanial in PCEA can improve the hemorheological parameters after total hip replacement and can be used as a effective method to reduce thrombosis.

关 键 词：舒芬太尼 硬膜外自控镇痛 血液流变学 全髋置换术 

分 类 号：R614.42[医药卫生—麻醉学]