舒芬太尼在颅骨修补术后自控静脉镇痛中的应用

摘要

目的 观察舒芬太尼应用于颅骨修补术后患者自控静脉镇痛中的镇痛效果及不良反应情况.方法 60例美国麻醉医师协会分级Ⅰ～Ⅱ级择期颅骨修补手术患者,完全随机分为吗啡组、芬太尼组和舒芬太尼组,各20例,术后行自控静脉镇痛,镇痛药物分别为吗啡1 mg/ml、芬太尼10μg/ml、舒芬太尼1μg/ml.比较行自控镇痛后的镇痛效果、不良反应及生命体征情况.结果 3组病例的镇痛效果均较满意,VAS评分以芬太尼组评分最高[(34.4±21.9)分],与吗啡组及舒芬太尼组[分别为(24.3±18.3)、(27.1±17.8)分]相比,差异有统计学意义(均P＜0.05).VRS评分以芬太尼组评分最低[(1.4±0.6)分],与吗啡组及舒芬太尼组[分别为(2.1±0.7)、(1.9±0.7)分]相比,差异有统计学意义(均P ＜0.05).芬太尼组24h平均药量与吗啡组、舒芬太尼组[3组分别为(40.3±19.2)、(26.6±12.9)、(28.9±12.9)ml]相比,差异有统计学意义(P＜0.01).3组患者的基本生命体征变化均在正常范围,平均动脉压、心率、呼吸频率3组间差异均无统计学意义(均P ＞0.05).吗啡组术后24h平均动脉压与术前相比[分别为(81.22±11.17)、(91.77±7.25)mm Hg]下降,差异有统计学意义(P＜0.05).3组中以吗啡组不良反应较多,恶心、呕吐、瘙痒的发生率最高,其中恶心8例(40％),瘙痒4例(20％),与舒芬太尼组(恶心、瘙痒各1例)相比,差异有统计学意义(P＜0.05).结论 目前常用的患者自控静脉镇痛方法都有确切的镇痛效果,其中舒芬太尼镇痛效果确切而不良反应较少,可望在脑科术后镇痛方面得到更广泛应用.%Objective To observe the effect and side effect of sufentanil in patient-controlled intravenous analgesia after cranioplasty.Methods Sixty ASA Ⅰ ～ Ⅱ patients undergoing elective cranioplasty were randomly divided into three groups.All patients in Group M,F and S received patient-controlled intravenous analgesia with 1 mg/ml morphine,10 μg/ml fentanyl or 1 μg/ml sufentanil.The analgesic effect,side effect and vital signs after applying PCIA were recorded.Results Effective analgesia could be achieved in all groups.VAS in group F was significantly less than those in the other groups and VRS was much higher ( P ＜ 0.05).There were more side effects in group M in which the incidence of nausea was the highest (8 cases).There was no significant difference of vital signs among the patients in three groups.Conclusions Postoperative patient-controlled intravenous analgesia could provide effective analgesia.Sufentanil could be used in PCIA after cranioplasty with satisfactory effect and less side effect which indicates the good prospect of sufentanil in neurosurgery postoperative analgesia.