不同剂量舒芬太尼用于下肢骨折患者术后皮下镇痛的疗效  

Comparison of different dosages of sufentanil in patient-controlled subcutaneous analgesia in patients with lower limb fractures

作　　者：程华春[1] 吴红[1] 刘永飞[1] 沈袁东 邵芸[1] 张慧君[2] 吕欣[2] 

机构地区：[1]上海市市东医院麻醉科,上海200438 [2]同济大学附属上海市肺科医院麻醉科

出　　处：《上海医学》2014年第8期662-665,共4页Shanghai Medical Journal

基　　金：上海市级医院适宜技术联合开发推广应用项目资助(SHDC12010214)

摘　　要：目的探讨不同剂量舒芬太尼用于皮下自控镇痛（PCSA）的疗效和安全性。方法选择60例行下肢骨折内固定手术的患者，美国麻醉医师学会（ASA）分级I至Ⅲ级，年龄26～88岁。根据舒芬太尼的剂量，将患者随机分入舒芬太尼0．08组、舒芬太尼0．06组、舒芬太尼0．04组，每组20例。3组舒芬太尼的背景剂量分别为0．08、0．06和0．04μg·kg-1·h-1，患者自控镇痛（PCA）单次剂量均为0．04μg／kg，锁定时间15min。3组患者分别于镇痛后3、6、12、24h时进行疼痛视觉模拟评分（VAS评分）和自诉分级疼痛评分（0VRS评分）、Ramesay镇静评分，监测脉搏血氧饱和度（SpO2），计算24h内舒芬太尼背景剂量、PCA舒芬太尼用量、舒芬太尼总量、每公斤体重的用量，以及PCA按压次数；并观察患者有无恶心呕吐等不良反应发生。结果舒芬太尼0．04组镇痛后6h的疼痛VAS评分显著高于舒芬太尼0．08组同时间点（P〈0．05），舒芬太尼0．06组镇痛后6h和舒芬太尼0．04组镇痛后6、24h的Ramesay镇静评分均显著低于舒芬太尼0．08组同时间点（P值均〈0．05）；舒芬太尼0．04组镇痛后6、12、24h的SpO2均显著高于舒芬太尼0．08组同时间点（P值均〈0．05），且镇痛后6、12h的S，0z均显著高于舒芬太尼0．06组同时间点（P值均〈0．05）。3组各时间点间的OVRS评分的差异均无统计学意义（P值均〉0．05）。舒芬太尼0．04组镇痛24h内的PCA按压次数和镇痛24h舒芬太尼PCA用量均显著多于舒芬太尼0．08组和舒芬太尼0．06组（P值均〈0．05）），而24h舒芬太尼背景剂量、24h舒芬太尼总量和每公斤体重舒芬太尼用量均显著少于舒芬太尼0．08组（P值均〈0．05）；舒芬太尼0．06组的24h舒芬太尼背景剂量亦显著少于舒芬太尼0．08组（P〈0．05））。舒芬太尼0．08组和舒芬太尼0．04组各有1例患者发生恶心呕吐，舒芬太尼0．06组Objective To explore the efficacy and safety of different dosages of sufentanil by patient- controlled subcutaneous analgesia （PCSA）. Methods Sixty patients undergoing internal fixation for lower limb fractures, American Society of Anesthesiologists （ASA） I - Ⅲ, aged 26-88 years, were recruited in the present study. They were randomly divided into three groups （n = 20） according to the background dose of sufentanil： group 0.08 pg · kg-1 · h-1, group 0.06 pg · kg-1 · h-1 and group 0.04 μg · kg- 1 · h-1 . In each group the single dose of sufentanil for patient-controlled analgesia patient controlled analgesia （PCA） was 0.04 μg/kg and the locking time was 15 min. Visual analog scale （VAS）, observer/verbal ranking scale （OVRS）, Ramesay sedation scores and pulse saturation of blood oxygen （SpO2） were recorded 3, 6, 12 and 24 hours after PCSA. The times of PCA press, the total amount of sufentanil for PCA, the total amount of background-dose sufentanil, the amount of per-kilogram and the total amount of sufentanil within 24 hours after PCSA were calculated. Adverse events such as nausea and vomiting were recorded. Results VAS score in group 0.04 μg · kg-1· h-1 was significantly higher than that in group 0.08 μg · kg-1 · h-1 at the time point of 6 hours after PCSA （all P〈0.05）. Ramesay sedation score in group 0.04 pg · kg- 1 · h- 1 at the time points of 6 and 24 hours after PCSA and in group 0.06 pg ·kg- 1 · h- 1 at the time point of 6 hours after PCSA were significantly lower than those in group 0.08 μg ·1 kg-1 · h-1 （all P〈0.05）. Sp O2 in group 0.04 pg · kg- 1 · h- 1 were significantly higer than those in group 0.08 pg · kg- · at the time points of 6, 12 and 24 hours after PCSA, and those in group 0.06 μg · kg-1 · h-1 at the time points of 6 and 12 hours after PCSA （all P d0.05）. There was no significant difference in OVRS score between groups （all P〉0.05）. Within 24 hours after PCSA, the times of PCA press and the total amount of sufent

关 键 词：舒芬太尼 皮下自控镇痛 下肢骨折 

分 类 号：R614[医药卫生—麻醉学]