三种不同剂量舒芬太尼用于术后硬膜外病人PCEA效应临床观察.docVIP

三种不同剂量舒芬太尼用于术后硬膜外病人PCEA效应临床观察 　【关键词】 子宫切除 ［摘要］ 目的:观察罗哌卡因复合不同剂量的舒芬太尼配伍用于子宫切除术术后硬膜外病人自控镇痛(PCEA)效果。方法:选择60例ASAⅠ级～Ⅱ级于硬膜外麻醉下行腹式子宫全切术的病人,随机分为三组(n=20)。术后行PCEA即负荷剂量(5 ml)+持续剂量(4 ml/h)+PCA剂量(1 ml/次),锁定时间20 min。A组镇痛用药为0.2%罗哌卡因+0.3 μg/ml舒芬太尼;B组为0.2%罗哌卡因+0.4 μg/ml舒芬太尼;C组为0.2%罗哌卡因+0.5 μg/ml舒芬太尼。双盲对照观察术后4 h、8 h、12 h、24 h内按压PCA次数、视觉模拟评分(VAS)、镇静评分、运动阻滞评分以及恶心、呕吐、眩晕等不良反应发生情况。结果:A组的镇痛评分明显高于B组、C组(Plt;0.05),B组与C组的镇痛评分比较差异无显著性(Pgt;0.05),恶心的发生率随舒芬太尼的剂量增大而增加,C组与A组、B组比较差异有显著性(Plt;0.05),三组病人生命体征稳定。结论:0.2%罗哌卡因复合0.4 μg/ml舒芬太尼行PCEA持续剂量4 ml/h,可为子宫切除术后病人提供满意的镇痛效果。 　　［关键词］ 硬膜外自控镇痛;舒芬太尼;罗哌卡因;子宫切除 　　Clinical Observation on the Effect of Patient Postoperative Controlled Epidural Analgesia with three Different Doses of Sufentanil 　　Abstract:Objectives To evaluate the effect of patient postoperativecontrolled epidural analgesia（PCEA）with different doses of sufentanil combined with 0.2% ropivacaine after hysterectomy.Methods Sixty patients（ASA Ⅰ～Ⅱ）underwent elective hysterectomy were randomly divided into three groups.Group A was given sufentanil 0.3 μg/ml+0.2% ropivacaine for PCEA,group B was given sufentanil 0.4 μg/ml +0.2% ropivacaine for PCEA,group C was given sufentanil 0.5 μg/ml+0.2% ropivacaine for PCEA.The PCEA device was programmed loading dose 5 ml,bolus of 1 ml with lock time 20 minutes and background 4 ml/h.The analgesia effects were evaluated by the number of PCA demand、visual analogue scales、 bruggrmann comfort scale and bromage score.Side effects such as nausea and vomiting were also recorded.Results The VAS scores were significantly higher in group A than that in group B and group C(Plt;0.05),the differences of VAS were not significant between group B and group C(Pgt;0.05).The incidence of nausea was related to the dose of sufentanil used and it was significantly higher in group C than that in group A and group B(Plt;0.05).The patients of three groups were uneventful.Conclusion 0.4 μg/ml sufentanil+0.2% ropivacaine is recommended for PCEA with background 4 ml/h was safe and effective fo