【摘要】 目的 比較舒芬太尼與等效劑量芬太尼在髖關(guān)節(jié)置換術(shù)后患者硬膜外鎮(zhèn)痛的臨床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髖關(guān)節(jié)置換術(shù)患者，隨機(jī)分為兩組（n=25）。芬太尼組（A組）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL；舒芬太尼組（B組），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL硬膜外鎮(zhèn)痛。其中，A組患者于手術(shù)結(jié)束時(shí)，靜脈滴注格拉司瓊3 mg。持續(xù)劑量2 mL/h，單次給藥量（PCA）0.5 mL/次，鎖定時(shí)間15 min。觀察兩組的鎮(zhèn)痛效果，惡心、嘔吐次數(shù)，記錄脈搏血氧飽和度、心率、呼吸的變化。 結(jié)果 鎮(zhèn)痛泵開機(jī)后，B組各時(shí)段鎮(zhèn)靜評(píng)分，2分以上者明顯多于A組，鎮(zhèn)痛評(píng)分明顯低于A組，有統(tǒng)計(jì)學(xué)意義（P lt;0.05），兩組術(shù)后惡心、嘔吐發(fā)生率都較低，組間差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。兩組4、12、24 h的呼吸頻率和脈搏血氧飽和度差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05），但48 h的呼吸頻率和脈搏血氧飽和度無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。 結(jié)論 在等效劑量下，髖關(guān)節(jié)置換術(shù)后患者硬膜外鎮(zhèn)痛，舒芬太尼明顯優(yōu)于芬太尼。
【Abstract】 Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement. Methods From December 2006 to September 2008, fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups, each group had 25 cases. Group A (fentanyl group): fentanyl mesylate 0.75 mg+0.894% ropivacaine 20 mL+0.9% sodium chloride solution to 100 mL; group B (sufentanil group): sufentanil 75 μg+0.894% ropivacaine mesylate 20 mL+0.9% sodium chloride solution to 100 mL epidural analgesia. Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery. Continuous dose was 2 mL/h, with the volume of single dose (PCA) 0.5 mL per time and lockout time of 15 minutes. The analgesic effect, nausea, and vomiting frequency were observed, and the pulse oxygen saturation, heart rate, and breathing changes were recorded. Results After boot analgesia, S sedation scores for each phase and pain score in group B were significantly different compared with those in group A (P lt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (P gt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (P lt;0.05), but at 48 h the difference was not significant (P gt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.
引用本文： 許伯林,杜禎華,王慶安,何峰,涂傳志,楊邦祥. 舒芬太尼用于髖關(guān)節(jié)置換術(shù)后患者自控硬膜外鎮(zhèn)痛的觀察. 華西醫(yī)學(xué), 2010, 25(7): 1307-1309. doi: 復(fù)制
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| 2. | Brodner C, Mertes N, van Aken H, et al. What concentration of sufentanil should be combined with ropivacaine 0. 2% wt/vol for post operative patient-controlled epidural for analgesia？[J]Anesth Analg, 2000, 90(3): 649-657. |
| 3. | 歐陽川, 卿恩明, 劉亞光, 等. 舒芬太尼對(duì)重癥先天性心臟病患兒體外循環(huán)后氧代謝的影響[J]. 中華麻醉學(xué)雜志, 2008, 28(12): 1061-1063. |
| 4. | Bailey PL, Streisand JB, East KA, et al. Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufetanil[J]. Anesth Analg, 1990, 70: 8-15. |
- 1. Niemegeers CJ, Schellekens KH, van Bever WF, et al. Sufentanil, a very potent and extremely sefe intravenous morphine-like compound in mice, rats and dogs[J]. Arzneimittelforschung, 1976, 26(8): 1551-1556.
- 2. Brodner C, Mertes N, van Aken H, et al. What concentration of sufentanil should be combined with ropivacaine 0. 2% wt/vol for post operative patient-controlled epidural for analgesia？[J]Anesth Analg, 2000, 90(3): 649-657.
- 3. 歐陽川, 卿恩明, 劉亞光, 等. 舒芬太尼對(duì)重癥先天性心臟病患兒體外循環(huán)后氧代謝的影響[J]. 中華麻醉學(xué)雜志, 2008, 28(12): 1061-1063.
- 4. Bailey PL, Streisand JB, East KA, et al. Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufetanil[J]. Anesth Analg, 1990, 70: 8-15.