舒芬太尼复合罗哌卡因用于开胸术后硬膜外镇痛的疗效

【目的】观察舒芬太尼或芬太尼复合罗哌卡因用于开胸手术后硬膜外自控镇痛（PCEA）的临床镇痛效果和安全性。【方法】ASAⅠ～Ⅱ级，全麻复合连续硬膜外阻滞麻醉行开胸手术病人70例，随机分为两组（n=35），使用0．75μg／ml舒芬太尼（S组）或3μg／ml芬太尼（F组）复合0．125％罗哌卡因，术后行PCEA。镇痛泵设定持续背景剂量2mL／h、PCA每次0．5mL，锁定时间15min。观察病人术后镇痛效果，记录术后4h、8h、12h、24h、48h各时间点的疼痛评分（VAS）、镇静评分、PCA使用次数、不良反应和病人满意度。【结果】S组术后8h、24h和48hVAS评分明显低于F组（P〈0．05）；S组各时间点镇静评分均明显大于F组（P〈0．05）；S组PCA按压次数显著低于F组（P〈0．05）；S组病人对PCA的满意度明显高于F组（P〈0．05）。两组恶心、呕吐发生率低，呼吸抑制相比无明显差异。【结论】舒芬太尼复合罗哌卡因用于开胸手术后PCEA，镇痛安全有效，镇痛镇静效果优于芬太尼，不良反应程度较轻。

Sufentanil Combined with Ropivacaine for Patient-controlled Epidural Analgesia in Patients Undergoing Thoracotomy

Objective] To investigate the efficacy and safe of sufentanil or fentanyl combined with ropivacaine for postoperative patient-controlled epidural analgesia（PCEA） in patients undergoing thoracotomy. Methods] Seventy ASAⅠ -Ⅱpatients undergoing thoracotomy with general anesthesia combining epidural anesthesia were randomly assigned to two groups. All the patients received postoperative analgesia with patient controlled epidural analgesia （ PCEA） ,and group sufentanil was given 0. 75μg/ml sufentanil and 0. 125% ropivacaine , and group fentanyl was given 3μg/ml fentanyl and 0. 125 % ropivaeaine. Background dose of analgesic pump was set to 2ml. The dose of every trigger of patient-controlled analgesia （PCA） was set to 0.5ml. The time of caging was 15min. The postoperative analgesia effects were observed. The score of analgesia and sedation were recorded after postoperative 4h,8b, 12h,24h and 48h. The trigger times of PCA, adverse effect and satisfaction of patients were collected. Results] The VAS of postoperative 8h,24h and 48h in group sufentanil had significant differences with group fentanyl （ P 〈0.05）. The sedative scores of each time in group sufentanil were much bigger than those of group fentanyl （ P 〈0.05）. The trigger time of PCA in group sufentanil was much smaller than that of group fentanyl. The incidence of postoperative nausea and vomiting in group sufentanil was lower than that of group fentanyl. The patients felt more satisfactory in group sufentanil than group fentanyl. Conclusion] Sufentanil combined with ropivacaine has a satisfactory effect on postoperative patient-controlled epidural analgesia in patients undergoing thoracotomy. The effeet of analgesia and sedation of sufentanil in PCEA was better than that of fentanyl, and can reduce and alleviate adverse effects.