不同浓度舒芬太尼用于食管癌根治术后患者皮下自控镇痛效果的观察

目的 比较不同浓度舒芬太尼用于食管癌术后患者皮下自控镇痛（PCSA）的效果。方法 选择行食管癌根治术的患者90例，采用随机数字表法分为Ⅰ~Ⅲ组，每组30例，分别给予舒芬太尼3、3.5、4 μg/ml，术后行PCSA 72 h。采用数字评分法（NRS）评价术后2、24、48、72 h的疼痛程度，用镇静反应程度评分标准（LOS）评估接受阿片类药物镇痛疗法患者的镇静程度。记录各组术后自控镇痛失败率、剩余药液量、患者按压自控镇痛键的总次数及常见不良反应（心动过缓、低血压和瘙痒）情况。结果Ⅰ组术后自控镇痛的失败率为43.3%（13/30），Ⅱ、Ⅲ组均为0。Ⅰ组剩余药液量为（18.1±0.7）ml，少于Ⅱ组的（33.5±0.2）ml和Ⅲ组的（33.2±0.3）ml，差异有统计学意义（P<0.05）。Ⅰ组的按压总次数为（8.1±0.6）次，高于Ⅱ组的（1.9±0.5）次和Ⅲ组的（2.1±0.3）次，差异有统计学意义（P<0.05）。Ⅰ组术后2、24、48 h的NRS评分高于Ⅱ组和Ⅲ组，差异有统计学意义（P<0.05）； Ⅰ组术后2、24、48、72 h的LOS评分低于Ⅱ组和Ⅲ组，差异有统计学意义（P<0.05）。Ⅲ组瘙痒、低血压及心动过缓的发生率较Ⅰ、Ⅱ组升高（P<0.05）。结论 舒芬太尼用于食管癌根治术后PCSA的适宜浓度为3.5 μg/ml。

Effect observation of different concentrations of sufentanil on patient controlled subcutaneous analgesia of postoperative patients receiving esophageal cancer radical surgery

Objective To compare effects of different concentrations of sufentanil on patient controlled subcutaneous analgesia( PCSA) after resection of esophageal carcinoma. Methods Ninety patients with esophageal cancer receiving radical surgery were enrolled in this study. Using the random number table, they were divided into 3 groups(Ⅰ-Ⅲ group, n=30) according to the do-ses of sufentanil (3, 3. 5, 4μg/ml) with PCSA for 2, 24, 48,72 h after the surgery. Postoperative pain degree was evaluated by nu-merical rating scale( NRS) . The degree of calm on patients receiving opioid analgesic therapy was evaluated by level of sedation( LOS) . The failure rate of patient-controlled analgesia, residual liquid quantity, the total number pressed by the patients with self-control anal-gesia and the occurrence of adverse reaction( bradycardia, hypotension and itching) were recorded. Results The failure rate of group Ⅰ was 43. 3%(13/30), and that of group Ⅱ and group Ⅲ was about 0. The amount of residual liquid in group Ⅰ was(18. 1±0. 7) ml, which was less than that in group Ⅱ(33. 5±0. 2) ml and group Ⅲ(33. 2±0. 3) ml, and the difference was statistically significant (P<0. 05). The total number of press times in group Ⅰ was 8. 1±0. 6, which was significantly higher than that in group Ⅱ(1. 9±0. 5) and group Ⅲ(2. 1±0. 3), and the difference was statistically significant(P<0. 05). The scores of NRS in group Ⅰ of 2, 24 and 48 h were higher than those in group Ⅱ and group Ⅲ and the difference was statistically significant( P<0. 05) . The score of LOS in group Ⅰ of 2, 24, 48 and 72 h was lower than those in group Ⅱ and group Ⅲ and the difference was statistically significant( P<0. 05) . The in-cidences of itching, hypotension and bradycardia in group Ⅲ were higher than those in group Ⅰ and Ⅱ( P<0. 05) . Conclusion The appropriate concentration of sufentanil on postoperative patients of esophageal cancer radical surgery with patient controlled subcutaneous analgesia is 3. 5 μg/ml.