不同舒芬太尼配置浓度对术后患者静脉自控镇痛效果和不良反应的影响  

Effect of Different Sufentanil Concentration Regimens on Postoperative Pain Control and Its Adverse Events in Intravenous Patient-controlled Analgesia

作　　者：徐嘉莹[1] 桑诺尔[1] 任丽英[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730

出　　处：《中国医学科学院学报》2017年第3期406-410,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的比较不同配置浓度的舒芬太尼对术后患者静脉自控镇痛(PCA)效果和不良反应的影响。方法回顾性分析2004年1月至2016年12月在北京协和医院收治的6231例择期全身麻醉术后使用舒芬太尼静脉PCA患者的临床资料,根据舒芬太尼配置浓度不同分为0.4μg/ml(SF4,n=1421)、0.6μg/ml(SF6,n=2489)、0.8μg/ml(SF8,n=1326)和1.0μg/ml(SF10,n=995)4组,比较4组间术后48 h内舒芬太尼用药总量、镇痛效果和不良反应的差异。结果4组患者的舒芬太尼术后48 h内药物用量总体积数(χ~2=87.316,P<0.001)和用药总量(χ~2=20.261,P<0.001)差异有统计学意义。4组患者术后第1天和第2天的静息以及运动VAS评分差异均无统计学意义(P均>0.05)。4组患者术后第1天的镇静程度评分差异有统计学意义(χ~2=9.042,P=0.029)。4组患者术后第1天(χ~2=7.855,P=0.012)和术后第2天(χ~2=5.635,P=0.044)的未排气发生率差异有统计学意义。其他不良反应各组间差异均无统计学意义(P均>0.05)。结论在全身麻醉术后使用舒芬太尼静脉PCA的患者中,较高的舒芬太尼配置浓度可能在不改善患者术后48 h镇痛效果的前提下提高镇静、肠道未排气等不良反应的发生率。Objective To compare the analgesic effect and incidences of adverse events of different sufentanil concentration regimens in postoperative intravenous patient-controlled analgesia（PCA）. Methods We retrospectively analyzed the clinical data of 6231 patients undergoing elective general anesthesia using sufentanil as postoperative intravenous PCA regimen in Peking Union Medical College Hospital from January 2004 to December 2016. These patients were subcategorized into 4 groups according to the sufentanil concentration regimens： 0. 4 μg/ml（SF4,n = 1421）,0. 6 μg/ml（SF6,n = 2489）,0. 8 μg/ml（SF8,n = 1326）,and1. 0 μg/ml（SF10,n = 995）. Total drug consumption within 48 h after surgery,analgesic effect,and incidences of adverse events were compared among these four groups. Results The cohort consisted of 2874 males（46. 1%） and 3357 females（53. 9%） in the age group from 3 years to 91 years（median： 52. 5 years）. The postoperative 48 h sufentanil consumption was significantly different among these four groups in terms of volume（χ~2= 87. 316,P〈0. 001） and dosage（χ~2= 20. 261,P〈0. 001）. Meanwhile,the VAS scores at rest and during activity on postoperative day 1（POD1） and POD2 showed no statistical significance among these four groups（both P〈0. 05）. As for the adverse events,the sedation score in POD1（χ~2= 9. 042,P = 0. 029） and incidence of no bowl movement on both POD1（χ~2= 7. 855,P = 0. 012） and POD2（χ~2= 5. 635,P = 0. 044）were significantly different among groups,whereas the incidences of other adverse events showed no significant difference（all P〈0. 05）. Conclusion In patients using intravenous sufentanil PCA as their postoperative analgesia regimen after general anesthesia,regimens with higher sufentanil concentrations may result in more adverse events such as sedation and no bowl movement without improving analgesic outcomes.

关 键 词：患者自控镇痛 舒芬太尼 VAS评分 不良反应 

分 类 号：R614.2[医药卫生—麻醉学]