【摘要】 目的 研究不同剂量舒芬太尼对左旋布比卡因硬膜外病人自控镇痛效应果影响。方法 择期全子宫切除术后患者100例，术后行硬膜外自控镇痛（PCEA），ASAⅠ～Ⅱ级，年龄35～60岁；随机分为五组，Ⅰ组:0.125%左旋布比卡因；Ⅱ组:0.125%左旋布比卡因+0.25 μg/ml舒芬太尼；Ⅲ组: 0.125%左旋布比卡因+0.5 μg/ml舒芬太尼；Ⅳ组:0.125%左旋布比卡因+0.75 μg/ml；Ⅴ组: 0.125%左旋布比卡因+1.0 μg/ml舒芬太尼，每组20例。采用视觉模拟评分（VAS）、Ramesay镇静评分、术后运动神经阻滞恢复评分（改良Bromage分级）观察镇痛效果；记录开机后4、8、16、20和24 h共5个时点的BP、HR、RR、SpO2以及静息和咳嗽时 VAS等数值、恶心和呕吐等不良反应及治疗措施。结果 五组病人年龄﹑体重﹑ASA分级、手术时间、术中利多卡因用量和手术结束前硬膜外腔最后一次给药时间基本相同（P＞0.05）。与Ⅰ组比较，Ⅲ组﹑Ⅳ组和Ⅴ组4、8、16、20、24 h时间点静息VAS和咳嗽VAS均显著降低（P＜0.05或0.01），Ⅰ组和Ⅱ组组间比较无统计学意义（P＞0.05），Ⅲ组﹑Ⅳ组和 Ⅴ组组间比较无统计学意义（P＞0.05）。与Ⅰ组比较，Ⅲ组﹑Ⅳ组和Ⅴ组24 h内恶心、呕吐及瘙痒等副反应发生率显著增高，Ⅰ组和Ⅱ组组间比较差异无统计学意义，Ⅳ组发生率明显低于Ⅳ、Ⅴ组。与Ⅰ组比较，Ⅲ组﹑Ⅳ组和Ⅴ组需追加曲马多辅助镇痛病例数减少。各组在4、8、16、20、24 h时间点未观察到血压心率异常变化及呼吸抑制，下肢肌力恢复良好，改良Bromage评分均为0级。结论 0.5 μg/ml舒芬太尼是0.125%左旋布比卡因最佳配伍剂量，镇痛效果好，副反应少，可作为妇科术后病人首选镇痛方案之一。
【关键词】 左旋布比卡因 舒芬太尼 硬膜外自控镇痛
【Abstract】 Objective To study effect of differentdose sufentanil on efficacy of levobupivacaine for patient-controlled epidural analgesia.Methods One hundred patients (ASA III,age 3560), scheduled for abdominal hysterectomy under epidural anesthesia, were randomly divided into 5 groups(n=20):group I received 0.125% levobupivacaine, group II received 0.125% levob combinedwith 0.25 μg/ml sufentanil, group III received 0.125% levob combined with 0.5 μg/ml suf, group IV received 0.125% levob combined with 0.75 μg/ml suf, group V received 0.125% levob combined with 1 μg/ml suf. The analgesic effects were assessed by using the visual analog scale (VAS), Ramsay sedation score, modified Bromage score. The following parameters were recorded at 4,8,16,20,24 h after pump infusion: blood pressure, heart rate, respiratory rate, oxygen saturation,VAS at rest and cough,the adverse events and treatment regiments.Results The general state of health was similar among 5 groups. Compared with group I,the VAS was lower in group III,IV,V at 4,8,16,20,24h, no diffenrence among group III,IV,V,and the incidence of adverse events was higher（P＜0.05）in group III,IV,V.The Ramsay score was 0 in all 5 groups. There was no statistical difference between group I and II. The patients need of tramadol was fewer in group III,IV,V than in group I.Conclusion In this study, we demonstrated that the concentration of 0.5% epidural sufentanil in combination with 0.125% levobupivacaine could obtain a good pain control with fewer adverse effects.
【Key words】 levobupivacaine, sufentanil, analgesia, epidural
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