舒芬太尼对老年病人的术后镇痛效果及血液流变学和凝血功能的影响  

Analgesic effect of sufentanil and the influence on postoperative hemorheology and coagulation function in the elderly patients

作　　者：秦素兰[1] 熊朝晖[1] 王波[1] 陈运良[1] 张春梅[1] 

机构地区：[1]广安市人民医院麻醉科,四川省广安市638000

出　　处：《实用老年医学》2015年第8期662-665,共4页Practical Geriatrics

基　　金：四川省卫生厅课题资助(100178)

摘　　要：目的观察舒芬太尼在老年骨科手术病人中的术后镇痛效果,同时观察术后镇痛对其血液流变学及凝血功能的影响。方法择期行脊柱后路手术的老年患者60例,分为术后持续镇痛组(P组)和对照组(C组)。观察术后4、12、24、48 h疼痛视觉模拟评分(VAS)及不良反应;检测术前1 d(T_0)和术后第1(T_1)、3(T_3)、7天(T_7)红细胞压积、血液流变学指标和凝血功能;术前1 d和术后第7天进行双下肢深静脉彩色多普勒超声检查。结果术后4、12、24 h各时点VAS评分P组明显低于C组,差异有统计学意义(P<0.05)。T_3、T_7时点全血低切黏度、血浆黏度、红细胞聚集指数、纤维蛋白原(FIB)、D-二聚体2组均比术前明显升高,但P组明显低于C组,差异有统计学意义(P<0.05)。术后第7天双下肢深静脉彩色多普勒超声检查2组均未见异常。结论舒芬太尼皮下镇痛对老年骨科手术病人术后镇痛效果良好,且有助于改善病人血液高黏滞度、高血凝状态。Objective To observe the postoperative analgesic effect of sufentanil in the elderly orthopedic patients,and to investigate the influence on hemorheology and coagulation function.Methods Sixty patients undergoing posterior spinal surgery were randomly divided into two groups,postoperative analgesia group（P group）,with sustained infusion of sufentanil subcutaneously,and control group（C group）.Visual analogue scale（VAS） was recorded 4,12,24 and 48 h after operation.Hematocrit（Hct）,hemorheology and coagulation function were detected 1 d before operation（T0）,and 1（T1）,3（T3）,7d（T7） after operation.Screening of lower limbs deep venous thrombus was performed by ultrasound before and 7 d after operation.Results The scores of VAS 4,12,24 h after the surgery in P group were obviously lower than those in C group respectively.The blood low viscosity,plasma viscosity,erythmcyte aggregation index,FIB,and plasma D-dimer level were significantly increased at T3 and T7 in both groups.At the same time,these indexes in P group were lower than those in C group（P〈0.05）.There was no deep venous thrombus in the two groups preoperatively and postoperatively.Conclusions The analgesic effect of subcutaneous infusion of sufentanil is effective and safe,and it is beneficial to improve hemorheology and coagulation function in the elderly orthopaedic patients.

关 键 词：舒芬太尼 术后镇痛 老年人 血液流变学 凝血功能 

分 类 号：R614.2[医药卫生—麻醉学]