硬膜外舒芬太尼超前镇痛的作用.docVIP

硬膜外舒芬太尼超前镇痛的作用 　　[摘要] 目的：观察舒芬太尼超前镇痛作用。方法：择期子宫全切手术患者40例，年龄20～60岁，ASA Ⅰ或Ⅱ级，随机分为两组，每组20例。Ⅰ组在切皮前硬膜外注入舒芬太尼10 μg，Ⅱ组为对照组，注入生理盐水2 ml。观察术中硬膜外用药量，术后感觉疼痛时间，镇痛药用量及术后VAS评分。结果：两组患者在手术时间上无统计学差异。术中麻醉药用量，与Ⅱ组比较，Ⅰ组明显减少（PⅠ组，两组VAS评分相似。结论：切皮前硬膜外注入小剂量舒芬太尼，能明显降低术后患者PCEA用药量，具有明显超前镇痛作用。 　　[关键词] 舒芬太尼；硬膜外麻醉；超前镇痛 　　[中图分类号] R614[文献标识码]B [文章编号]1673-7210（2008）06（b）-078-02 　　 　　Effects of preemptive analgesia of sufentanil in epidural using 　　WANG Jin-feng*，XIN Xiu-ying，DING Bin 　　（Department of Anesthesiology，Weifang Peoples Hospital，Weifang 261041，China） 　　[Abstract] Objective: To observe preemptive analgesia of sufentanil in epidural using.Methods:Forty ASAⅠorⅡpatients aged 20~60 years undergoing total hysterectomy under epidural anesthesia were randomly divided into two groups:groupⅠwas given sufentanil 10 μg epidurally before skin incision. GroupⅡwas given 0.9% saline 2 ml.The required dosages of anesthetics in operation，postoperative time of aching，the postoperative required analgesic dosage and VAS score of patients controlled epidural analgesia were observed. Results: The required dosage of anesthetics in operation was markly lower in group Ⅰ than that in groupⅡ.The postoperative time of aching was significantly longer in group Ⅰ than that in groupⅡ. The postoperative required analgesic dosage was obviously smaller in groupⅠthan that in groupⅡ. The VAS scores of two groups were similar.Conclusion:Small dose of epidural sufentanil before skin incision can lower the required analgesic dosage after operation，preemptive analgesia is produced effectively. 　　[Key words] Sufentanil; Epidural anesthesia;Preemptive analgesia 　　 　　超前镇痛是指术前即对伤害性感受加以阻滞而达到术后止痛或减轻疼痛的目的[1]。舒芬太尼是新一代强效阿片受体激动剂，本研究旨在探讨其在硬膜外麻醉中的超前镇痛作用。 　　1 资料与方法 　　1.1病例选择及分组 　　选择择期硬膜外麻醉下子宫全切手术患者40例，ASAⅠ～Ⅱ级，年龄20～60岁，随机分为两组（每组20例）。 　　1.2 麻醉方法 　　两组患者入室后均行L1～2硬膜外穿刺，朝头端置管4 cm，硬膜外用药为2%利多卡因，在试验剂量（2%利多卡因5 ml）测出平面后，Ⅰ组硬膜外给舒芬太尼10 μg，Ⅱ组给生理盐水2 ml，5 min后给2%利多卡因8～10 ml，术中根据需要追加药量，术后都采用爱朋电子泵患者自控镇痛（PCEA），0.75%布比卡因35 ml+吗啡20 mg用生理盐水稀释到200 ml，PC