不同浓度舒芬太尼及芬太尼对术后皮下镇痛效果的评价

Optimal concentrations of sufentanil and fentanyl for postoperative subcutaneous analgesia

关键词:  舒芬太尼  芬太尼  骨折内固定  皮下镇痛

Key words:  sufentanil  fentanyl  internal fixation  PCA

摘要:

目的探讨舒芬太尼和芬太尼用于胫腓骨骨折内固定术后患者自控皮下镇痛（patient-controlled subcutaneous analgesia, PCSA)的等效剂量比及其临床效果。方法选择75例，ASA I ~ II级,择期在腰硬联合麻醉下行胫腓骨骨折内固定术后的男性患者，随机平分为不同浓度的舒芬太尼组1(S1)、舒芬太尼组2(S2)和芬太尼组（F),分别给予舒芬太尼0.2、0.3 mg/100 ml及芬太尼2 mg/100 ml。行术后PCSA,观察其镇痛后24、36 h镇痛药液消耗量，疼痛视觉评分,镇静评分,呕心呕吐评级。结果S2和F组都取得了良好的镇痛效果,S2组术后 24、36 h镇痛药液消耗量与F组相当，术后36 h VAS评分S2组优于F组。S1组术后24、36 h镇痛药液消耗量和VAS评分均明显高于F组，S1组的镇痛效果不如F组。三组镇静评分及恶心呕吐差异无统计学意义。结论舒芬太尼与芬太尼按1:6.7的等效剂量比用于术后皮下镇痛是安全可行的。

Abstract:

Objective To determine the optimal concentration of sufentanil and fentanyl in patient-controlled subcutaneous analgesia (PCSA) after orthopedic surgery.Methods Seventy five patients, ASA I-II，undergoing elective internal fixation for tibia or fibula fracture were randomized into three groups ： SI，S2 and F. After surgery patients in groups SI and S2 received 0.2 mg/100 ml or 0.3 mg/100 ml sufentanil, those in group F received 2 mg/100 ml fentanyl for PCSA, respectively. Drug consumption, visual analogue scale (VAS)，sedation score (Ramsay) and nausea and vomiting grades at postoperative 24 h and 36 h were observed and compared. Results Satisfactory analgesic effect was achieved in both S2 and F groups. Drug consumption in S2 group at postoperative 24 h and 36 h was equivalent to that in F group. Better analgesic effect was seen in group S2 than in group F as judged by VAS values with significant difference. Drug consumption and VAS value in group SI at postoperative 24 h and 36 h were higher than that those in group F，suggesting a poorer analgesic effect in this group. No significant difference was shown in Ramsay scores, and nausea and vomiting grades among these three groups. Conclusion An equivalence of 1:6.7 of fentanyl to sufentanil for PCSAwas identified and their delivery at this dosage was proven to be safe and feasible.