舒芬太尼用于胸部肿瘤患者术后硬膜外自控镇痛的临床研究

目的以芬太尼为对照,比较不同剂量舒芬太尼复合布比卡因用于胸部肿瘤手术后硬膜外自控镇痛的临床效果和安全性。方法60例择期开胸行食管、肺叶肿瘤切除术后病人,随机双盲分为4组,每组15例,术后硬膜外镇痛分别使用舒芬太尼0·25μg/ml(Ⅰ组)、0·5μg/ml(Ⅱ组)、0·75μg/ml(Ⅲ组)及芬太尼5μg/ml(Ⅳ组)。记录术后第4、8、12、24、48小时的镇痛效果、镇静程度,各组可能出现的皮肤瘙痒、恶心呕吐等不良反应。结果与Ⅰ组对应值比较,Ⅱ、Ⅲ组VAS、VAFS评分降低,差异有显著性(p<0·05或p<0·01);与Ⅱ组对应值比较,Ⅲ组VAS、VAFS评分降低,差异有显著性(p<0·05)。各时点Ramsay镇静评分:Ⅰ组术后8-24小时评分低于其他各组对应值,差异有显著性(p<0·05)。结论舒芬太尼复合低浓度布比卡因用于胸部肿瘤手术后硬膜外自控镇痛临床效果好,副作用小,舒芬太尼推荐浓度以0·75ug/ml为宜。

Clinical Study of Sufentanil in Postoperative Patient-controlled Epidural Analgesia for Patients with Chest Tumors

Objective To compare the clinical effect and safety of different concentration of sufentanil combined with bupivacaine for patient-controlled epidural analgesia(PCEA) after thoracic operation.Methods Sixty patients(ASA Ⅰ-Ⅲ) undergone thoracic surgery were assigned at random and double-blind method to four groups for receiving PCEA with sufentanil 0.25 μg/ml(groupⅠ,n=15), sufentanil 0.50μg/ml(group Ⅱ,n=15), sufentanil 0.75 μg/ml(group Ⅲ,n=15)and fentanyl 5 μg/ml(groupⅣ,n=15). In each group, the concentration of bupivacaine was 0.188%, and 100ml analgesia fluid included droperidol 5mg. Visual analogue scales(VAS), visual analogue fatigue scales (VAFS), Ramsay scales and side-effects including pruritus, nausea and emesis were assessed after the 4th,8th,12th,24th and 48th hour of postoperative analgesia.Results After the 48th hour of postoperative analgesia, VAS and VAFS scores both in group Ⅱ and group Ⅲ were lower than that in groupⅠ(p<0.05 or p<0.01).VAS and VAFS in group Ⅲ were lower than that in group Ⅱ (p<0.05). In groupⅠ,the Ramsay scores at the 8th to the 24th hour after operation were lower than that in the other groups (p<0.05). Conclusion Sufentanil combined with lower concentration bupivacaine is suitable for PCEA after thoracic operation,and the dose of sufentanil 0.75ug/ml can obtain a better postoperative analgesia.