【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，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)痛泵開機后，B組各時段鎮(zhèn)靜評分，2分以上者明顯多于A組，鎮(zhèn)痛評分明顯低于A組，有統(tǒng)計學(xué)意義（Plt;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)計學(xué)意義（Pgt;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)計學(xué)意義（Plt;0.05），但48 h的呼吸頻率和脈搏血氧飽和度無統(tǒng)計學(xué)意義（Pgt;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?！続bstract】 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 (Plt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (Pgt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (Plt;0.05), but at 48 h the difference was not significant (Pgt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.
疲勞是由長時間的體力和腦力勞動所導(dǎo)致的一種身心疲憊狀態(tài),亦是降低工作績效、誘發(fā)工傷事故的重要因素之一。疲勞會導(dǎo)致注意力不集中、工作績效下降,誘發(fā)慢性疾病,長期疲勞還會危及生命安全。在大部分高負荷工作任務(wù)與復(fù)雜場所環(huán)境下人的疲勞是由腦力疲勞和體力疲勞共同所致。因此研究體腦疲勞交互影響及神經(jīng)生理機制有重要的科學(xué)意義與應(yīng)用價值。本文介紹了近幾年有關(guān)體、腦疲勞方面的研究情況,并歸納了體腦疲勞交互影響機制研究的初步進展,總結(jié)了目前存在的研究難點與未來可能的發(fā)展方向。體腦疲勞的相互影響可能發(fā)生在中樞神經(jīng)系統(tǒng),揭示基底神經(jīng)節(jié)功能及多巴胺釋放規(guī)律可能是解讀體腦疲勞交互影響神經(jīng)機制的關(guān)鍵;今后還需要在疲勞誘發(fā)實驗設(shè)計優(yōu)化、檢測評價參數(shù)優(yōu)選和體腦疲勞神經(jīng)建模等方面做深入研究,以為復(fù)雜工作任務(wù)設(shè)定提供科學(xué)依據(jù)和理論指導(dǎo),為疲勞監(jiān)測、疲勞對抗提供科學(xué)方法和技術(shù)支撐。