舒芬太尼与芬太尼在剖宫产术后PCIA中的镇痛效果及对应激反应、血流动力学的影响  

Analgesic effect of sufentanil and fentanyl for PCIA and their influences on stress response and hemodynamics after cesarean section

作　　者：梅芳 俞丽英 潘夏飞 周晓敏 Mei Fang;Yu Li-ying;Pan Xia-fei;Zhou Xiao-min(Department of Pharmacy,Guangfeng District Maternal and Child Health Hospital,Shangrao 334600,Jiangxi,China;Department of Obstetrics and Gynecology,Guangfeng District Maternal and Child Health Hospital,Shangrao 334600,Jiangxi,China)

机构地区：[1]江西省上饶市广丰区妇幼保健院药剂科,江西上饶334600 [2]江西省上饶市广丰区妇幼保健院妇产科,江西上饶334600

出　　处：《四川生理科学杂志》2024年第10期2217-2219,2253,共4页

摘　　要：目的:探讨舒芬太尼与芬太尼在剖宫产术后静脉自控镇痛(Patient controlled intravenous analgesia,PCIA)中的镇痛效果及对应激反应、血流动力学的影响。方法:回顾性分析2022年6月至2024年6月我院行剖宫产手术的96例患者资料,根据术后PCIA中用药方案的不同分为A组(n=42,采用枸橼酸芬太尼注射液)和B组(n=54,采用枸橼酸舒芬太尼注射液)。分别于术后6 h、12 h和24 h采用视觉模拟评分(Visual analogue pain score,VAS)和Ramsay镇静评分表评估镇痛镇静效果。分别于术前、术后2 h采用酶联法检测超敏C-反应蛋白(High-sensitivity C-reactive protein,hs-CRP)和内皮素-1(Endothelin-1,ET-1),采用高效液相色谱法检测去甲肾上腺素(Noradrenaline,NE),采用放射免疫法检测血浆皮质醇(Cortisol,COGT)。分别于术前、术后2 h采用心电监护仪记录平均动脉压(Mean arterial pressure,MAP)、心率(Heart rate,HR)、血氧饱和度(Oxyhemoglobin saturation,SpO2)水平;并评价两组患者药物安全性。结果:术后6 h、12 h和24 h,B组患者VAS及Ramsay评分均明显低于A组(P<0.05);术后2 h两组hs-CRP、COGT、NE、ET-1、HR、MAP、SpO2水平均升高,但B组上述指标水平较A组更低(P<0.05);两组总不良反应率比较无差异(11.11%vs 23.81%)(P>0.05)。结论:相较于芬太尼,舒芬太尼用于剖宫产术后PCIA中的镇痛效果更优,有利于维持血流动力学稳定,且对产妇的应激反应小,并具安全性。Objective:To explore the analgesic efficacy,stress response,and hemodynamic effects of sufentanil and fentanyl in patient-controlled intravenous analgesia(PCIA)after cesarean section.Methods:Retrospective analysis of the data of 96 patients who underwent cesarean section in our hospital from June 2022 to June 2024.According to the different medication regimens in the postoperative PCIA,they were divided into group A(n=42,using fentanyl citrate injection)and group B(n=54,using sufentanil citrate injection).The analgesic and sedative effects were evaluated using the Visual analogue pain score(VAS)and Ramsay sedation scale at 6,12,and 24 hours after surgery.High-sensitivity C-reactive protein(hs-CRP)and endothelin-1(ET-1)were detected by enzyme-linked immunosorbent assay before and 2 hours after surgery,and noradrenaline(NE)was detected by high performance liquid chromatography.Plasma cortisol(COGT)was detected by radioimmunoassay.The mean arterial pressure(MAP),heart rate(HR),and oxygen saturation(SpO2)were recorded using an electrocardiogram monitor before and 2 hours after surgery,and evaluate the safety of drugs in the two groups of patients.Results:At 6,12,and 24 hours post-surgery,the VAS and Ramsay scores in Group B were significantly lower than those in Group A(P<0.05).Two hours after surgery,the levels of hs-CRP,COGT,NE,ET-1,HR,MAP,and SpO2 increased in both groups,but the levels of these indicators in group B were lower than those in group A(P<0.05).There was no significant difference in the overall adverse reaction rate between the two groups(11.11%vs 23.81%)(P>0.05).Conclusion:Compared with fentanyl,sufentanil has better analgesic effect in PCIA after cesarean section,which is beneficial to maintaining stable hemodynamics,and has less stress response on the parturient and is safe.

关 键 词：舒芬太尼 芬太尼 剖宫产 静脉自控镇痛 应激反应 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R71[医药卫生—外科学]