老年患者行全髋关节置换术后硬脊膜外腔镇痛舒芬太尼最适质量浓度的研究  

Optimal mass concentration of sufentanil for patient controlled epidural analgesia after hip replacement in the aged

作　　者：彭洁[1] 甘林光[1] 陈骏萍[1] 

机构地区：[1]宁波市第二医院麻醉科,浙江315010

出　　处：《上海医学》2012年第6期480-483,共4页Shanghai Medical Journal

摘　　要：目的探讨老年患者行全髋关节置换术后硬脊膜外腔镇痛所用舒芬太尼的最适质量浓度。方法 80例行全髋关节置换术的老年患者均在术后行患者自控硬脊膜外腔镇痛(PCEA),随机分为L组(予0.1%罗哌卡因)、S1组(予0.1%罗哌卡因+0.25μg/mL舒芬太尼)、S2组(予0.1%罗哌卡因+0.5μg/mL舒芬太尼)及S3组(予0.1%罗哌卡因+0.75μg/mL舒芬太尼),每组20例。记录患者PCEA后2h(T1)、6h(T2)、12h(T3)、24h(T4)及48h(T5)疼痛视觉模拟评分(VAS评分),以及快速注射(bolus)次数、不良反应情况(低血压、恶心呕吐、瘙痒、下肢麻木、过度镇静和呼吸抑制)、镇痛满意度。结果术后T2、T3、T4及T5时间点,S1、S2及S3组的疼痛VAS评分均显著低于L组同时间点(P值均<0.05),S1、S2及S3组间相同时间点疼痛VAS评分的差异均无统计学意义(P值均>0.05)。与L组比较,S3组恶心呕吐和瘙痒的发生率显著升高(P值均<0.05),S2、S3组下肢麻木的发生率显著降低(P值均<0.05);与L、S1及S2组比较,S3组过度镇静及瘙痒的发生率显著升高(P值均<0.05);与L组比较,S1、S2及S3组的低血压发生率显著降低(P值均<0.05)。S1、S2和S3组的bolus次数较L组显著减少(P值均<0.05),S2和S3组又较S1组显著减少(P值均<0.05)。与L、S1和S2组比较,S3组的镇痛不满意率显著升高(P值均<0.05)。结论 0.5μg/mL舒芬太尼既可满足老年患者术后镇痛的需要,又能够最大程度地减少阿片类药物的不良反应,0.5μg/mL可作为老年患者全髋置换术后硬脊膜外腔镇痛舒芬太尼的最适质量浓度。Objective To investigate the optimal mass concentration of sufentanil for patient controlled epidural analgesia （PCEA） after replacement of total hip in the elderly. Methods Eighty aged patients scheduled for hip replacement were randomly divided into group L （0. 1% ropivacaine）, group S1 （0. 1% ropivacaine＋ 0.25 μg/mL sufentanil）, group S2 （0.1% ropivacaine＋ 0.50μg/mL sufentanil） and group S3 （0.1% ropivacaine＋ 0.75 μg/mL sufentanii）. There were 20 patients in each group. PCEA were performed in all the patients. Visual analogue scale （VAS） scores, bolus times, adverse reaction （such as hypotension, nausea/vomiting, pruritus, lower limber numbness, sedation and respiratory depression） and analgesic satisfaction were evaluated at 2 h （T1）, 6 h （T2）, 12 h （T3）, 24 h （T4）, 48 h （T5） after PCEA. Results VASscores in groups S1, S2 andS3 were significantly lower than those in group L at T2, T3, T4 and T5 （all P〈0.05）. But there were no significant differences in VAS scores among groups S1, S2 and S3 at the above time points （P〉0.05）. Compared with group L, the incidence of postoperative nausea/vomiting and pruritus was significantly increased in group S3, the incidence of numbness in groups S2 and S3 and the incidence of hypotension and bolus times in groups S1, S2 and S3 were significantly decreased （all P〈0.05）. Bolus times in groups S2 and S3 were significantly less than group S1 （both P〈0.05）. Compared with groups L, S1 and S2, the incidence of over-sedation and dissatisfaction were significantly increased in group S3 （all P〈0.05）. Conclusions 0.5 μg/mL sufentanil can not only meet therequirement of PCEA for elderly patients, but also minimize the adverse effects of opioids, it is the most suitable concentration for PCEA in the replacement of total hip in elderly patients.

关 键 词：舒芬太尼 硬脊膜外腔镇痛 髋关节置换 老年 

分 类 号：R614[医药卫生—麻醉学]