南方医科大学学报

南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (02): 240-.

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舒芬太尼和芬太尼用于开胸术后病人自控静脉镇痛的比较研究

林春水； 卢刚； 阮骆阳； 古妙宁；   

  1. 南方医科大学南方医院麻醉科； 南方医科大学南方医院麻醉科 广东广州510515； 广东广州510515；
  • 出版日期:2006-02-20 发布日期:2006-02-20

Patient-controlled intravenous analgesia with sufentanil and fentanyl after thoracotomy: a comparative study

LIN Chun-shui, LU Gang, RUAN Luo-yang, GU Miao-ning Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China   

  1. 南方医科大学南方医院麻醉科； 南方医科大学南方医院麻醉科 广东广州510515； 广东广州510515；
  • Online:2006-02-20 Published:2006-02-20

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摘要： 目的观察比较等效剂量舒芬太尼和芬太尼用于开胸术后病人自控静脉镇痛(PCIA)的效果及其不良反应。方法选择ASA Ⅰ～Ⅱ级、年龄20～60岁择期全麻下行开胸手术患者60例,随机分为芬太尼组(F组)和舒芬太尼组(S组),每组30例。全麻诱导后双腔管气管内插管,两组术中吸入异氟烷、间断肌肉注射罗库溴铵维持全麻。病人清醒拔除气管导管后接韩国奥美2300电子镇痛泵行PCIA。F组:芬太尼2 mg、咪唑安定10 mg、生理盐水稀释至200 ml;S组:舒芬太尼0．2 mg、咪唑安定10 mg、生理盐水稀释至200 ml。背景剂量2．5 ml／h,指令剂量2．5 ml／次,锁定时间15 min。所有病人术后鼻导管吸氧2～3 L／min,分别记录术后24、48 h的疼痛[视觉模拟评分(VAS)法]、镇静、恶心和呕吐评分,记录脉搏氧饱和度、心率、呼吸频率、平均动脉压和累计镇痛药消耗量。结果 S组术后24、48 h镇痛药耗量和VAS评分均低于 F组,其中术后48 h VAS评分有显著性差异(P<0．05);S组术后24 h镇静优于F组(P<0．05);S组术后48 h恶心、呕吐者明显少于F组(P<0．05):两组术后48 h内无一例呼吸抑制(脉搏氧饱和度持续低于90％者)发生。两组术后24、48 h 脉搏氧饱和度、心率、呼吸频率和平均动脉压均无显著差异(P>0．05)。结论等效剂量的舒芬太尼用于开胸术后PCIA,镇痛、镇静效果优于芬太尼,而恶心、呕吐发生率较芬太尼低,是开胸术后更为安全、有效的镇痛方法。

Abstract: Objective To evaluate the clinical efficacy of sufentanil and fentanyl at equivalent dose for patient-controlled intravenous analgesia (PCIA) after thoracotomy. Methods Sixty ASA Ⅰ-Ⅱ patients (20-60 years of age) undergoing radical operation for lung or esophageal cancer were randomly divided into sufentanil intravenous analgesia group (group S, with sufentanil 1 μg/ml) and fentanyl intravenous analgesia group (group F, fentanyl 10 μg/ml). PCIA was administered with background infusion of 2.5 ml/h , bolus injection of 2.5 ml and lockout time of 15 min. The pain intensity according to visual analogue scale (VAS), cumulative analgesic consumption (CAC), sedative scores and side effects at 24 and 48 h after administration were recorded. SpO2, respiratory rate (RR), blood pressure (BP) and ECG were continuously monitored. Results There were no significant differences in CAC between the two groups, but he VAS was lower in group S than in group F (P<0.05) and the sedative efficacy was superior in group S (P<0.05). The incidence of nausea and vomiting in group S was lower than that in group F (P<0.05). No significant differences were observed in SpO2, RR, heart rate and mean arterial pressure between the two groups. Conclusion PCIA with sufentanil provides better efficacy of analgesia and sedation with lower incidence of nausea and vomiting than with fentanyl in postoperative patients with thoracotomy. 

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