摘要
目的观察等效剂量的芬太尼与舒芬太尼应用于骨科全髋置换术后患者静脉自控镇痛(PCIA)的镇痛效果和不良反应。方法选择择期全麻下行全髋置换术的患者61例,随机分为F组(31例)和S组(30例)。手术结束时。给予负荷量芬太尼0．04mg和氟哌利多1．5mg静脉注射,接美国百特APⅡ型微型计算机镇痛泵行PCIA,F组的药物配方为芬太尼28μg/kg+0．9%氯化钠溶液100mL,S组为舒芬太尼2．8μg/kg+0．9%氯化钠溶液100mL。背景剂量为1mL/h,患者自控镇痛(PCA)泵单次给药剂量为1mL,锁定时间为15min。分别记录术后2、4、8、20、24及48h的动、静态疼痛视觉模拟(VAS)评分以及镇静、恶心、呕吐评分,记录脉搏血氧饱和度、心率、呼吸频率、镇痛药消耗量及有效与实际按压次数比。结果两组术后48h内静态VAS评分的差异均无统计学意义(P值均＞0．05);S组动态VAS评分均低于F组,但仅术后4和8h的差异有统计学意义(P值均＜0．05)。两组镇痛药消耗量的差异均无统计学意义(P值均＞0．05)。S组患者术后2～4h和4～8h两个时间段内的PCA泵有效与实际按压次数比明显高于F组(P值均＜0．05)。术后4h内,两组的呼吸频率和脉搏血氧饱和度均较术前明显下降(P值均＜0．05),且2h时F组明显低于S组(P值均＜0．05)。术后20h内,S组的镇静评分显著高于F组(P值均＜0．05)。两组术后恶心、呕吐发生率的差异均无统计学意义(P值均＞0．05)。结论与等效剂量的芬太尼相比,舒芬太尼应用于全髋置换术后PCIA的镇痛作用更为完善、确切,其镇静作用强于芬太尼,而呼吸抑制比芬太尼弱。
Objective To compare the analgesic efficacy and complications between equivalent dose of sufentanil and fentanyl in patient controlled intravenous analgesia for total hip arthroplasty. Methods Sixty-one patients undergoing total hip arthroplasty were randomly divided into twogroups： fentanyl 28 μg/kg in F group（ n = 31 ） and sufentanil 2.8 μg/kg in S group（ n = 30 ）. Each drug was diluted to 100 mL and infused by an electric pump at a rate of 1 mL/h with a patient-controlled bolus of 1 mL after a loading dose of fentanyl 0.04 mg and droperidol 1.5 mg. The visual analog scale（VAS） of patient controlled analgesia（PCA）, drug consumption and incidence of side effects were recorded within 48 hours postoperatively. Results The VAS of two groups were similar at rest. The VAS values of group F at 4 and 8 h after operation were significantly higher than those of group S on exertion （all P 〈 0.05）, which became similar when at rest. The consumption of analgesic drugs was comparable between the two groups ; but the time required for supplemental bolus in group F was significantly higher than that of group S（all P 〈 0.05） during postoperative 2-8 hours period. The respiration rate（RR） and oxygen saturation（SpO2 ） dropped significantly within 4 h in both groups, and the drop of group F was more obviously than group S 2 h after operation（all P 〈 0.05）. The degrees of sedation in group S at various time points were significantly deeper than those of group F（all P 〈 0.05） in the first 20 hours after operation. The incidences of nausea and vomiting were similar in both groups. Conclusion Intravenous postoperative analgesia with equivalent dose of sufentanil has a better analgesic effect than fentanyl. The sedation effect is stronger and the respiratory depression is less in patients receiving sufentanil compared with those receiving fentanyl. （Shanghai Med J, 2007, 30：404 407）
出处
《上海医学》
CAS
CSCD
北大核心
2007年第6期404-407,共4页
Shanghai Medical Journal
关键词
舒芬太尼
芬太尼
术后镇痛
等效剂量
Sufentanil
Fentanyl
Postoperative analgesia
Equivalent close
