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不同剂量舒芬太尼用于下肢骨折患者术后皮下镇痛疗效比较
Comparison of effect of patient-controlled subcutaneous analgesia with different dosages of sufentanil on postoperative pain therapy in patients with lower limb fractures
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DOI:
作者:
吴红
Cheng Hua-chun , Wu Hong, Liu Yong-fei, Shen Yuan-dong, Shao Yun, Zhang hui jun, Lv xin.
作者单位:
上海市杨浦区市东医院麻醉科 同济大学附属上海市肺科医院麻醉科
Department of Anesthesiology, Shidong Hospital, Yangpu District, Shanghai, 200438, China
关键词:
舒芬太尼; 皮下镇痛; 下肢骨折
Sufentanil ; PCSA; lower limb fractures
摘要:
【摘要】目的 探讨不同剂量舒芬太尼皮下镇痛的疗效及安全性。方法 选择行下肢骨折内固定手术患者60例,ASAI~III,年龄26~88岁。根据舒芬太尼的不同剂量随机分为I组(0.08µg/kg•h);II组(0.06µg/kg•h);III组(0.04µg/kg•h),各组均为20例。每组舒芬太尼PCA单次剂量为0.04µg/kg,锁定时间15min。每组分别在镇痛后3、6、12、24h时进行VAS和OVRS疼痛评分、镇静评分,监测SpO2,观察恶心呕吐等副反应,并计算24h内舒芬太尼背景总量、PCA舒芬太尼总量、24h舒芬太尼总量、24h每公斤体重的用量及PCA按压次数。结果 III组在镇痛后6h的VAS评分显著高I组(p<0.05)。III组在镇痛后6、24h及II组在镇痛后6h的镇静评分显著低于I组(p<0.05),III组在镇痛后6、12、24h的SpO2显著高于I组(p<0.05),且6、12h的SpO2也显著高于II组(p<0.05)。III组在镇痛的24h内的PCA按压次数、舒芬太尼PCA量均高于I组和II组(p<0.05),而24h背景量、24h舒芬太尼总量和每公斤体重用量显著低于I组(p<0.05),II组的24h背景量也显著低于I组(p<0.05)。不良反应中,I组和III组各有1例恶心呕吐。结论 三组不同剂量的舒芬太尼PCSA均能取得良好的镇痛疗效,但从安全性来考虑,PCSA以II组、III组剂量较为适宜,特别是老年患者,尤以II组为宜,既用较小的背景剂量,又不至于频繁使用PCA,且24h舒芬太尼总量(µg)每公斤体重用量(µg/kg)也较少。
[Abstract] Objective To explore the efficacy and safety among different dosages of sufentanil by patient-controlled Subcutaneous Analgesia(PCSA). Method Sixty postoperative patients were randomly divided into three groups according to the dosages of sufentanil: groupI(0.08µg/kg•h); groupII(0.06µg/kg•h) and groupIII(0.04µg/kg•h). In each group the single dose of sufentanil for PCA was 0.04µg/kg•each time and the lock time was 15 min. Visual analog scale (VAS), observer/verbal ranking scale (OVRS), sedation scores(Ramesay) and SpO2 were recorded at each point of 3、6、12、24 hours after PCSA, and side effects were recorded such as nausea and vomiting and so on. It were calculated for the times of PCA press, the total amount of sufentanil for PCA, the total amount of background dose sufentanil , the amount of Per kilogram and the total amount of sufentanil within 24 hours after PCSA for each group. Results Compared with groupI, VAS scores in group III was significantly higher (p<0.05) at point of 6 hours after PCSA . Sedation scores in group III at point of 6、24hours and in group II at point of 6hours after PCSA were less than that in group I(p<0.05). SpO2 in group III was significantly higher than that in group I at the point of 6、12、24hours after PCSA,(p<0.05). In addition, SpO2 in group III was also significantly higher than that in group II at point of 6、12hours after PCSA(p<0.05). Within 24 hours after PCSA ,the times of PCA press, the total amount of sufentanil for PCA in group III were significantly higher than that in group I and group II (p<0.05), but the total amount of background dose sufentanil , the amount of Per kilogram and the total amount of sufentanil within 24 hours after PCSA were significantly lower than that in group I(p<0.05) , the total amount of background dose sufentanil within 24 hours in group II were significantly lower than that in group I (p<0.05). In adverse reactions, there was one patient happening such as mild nausea and vomiting in group I and group III respectively. Conclusion Three groups are able to obtain satisfactory analgesic effect, But from the safety consideration, the dose of group II and group III is relatively appropriate, especially in elderly patients. Particularly in group II, the total amount of background dose、the amount of Per kilogram and the total amount of sufentanil within 24 hours after PCSA were lesser, Without frequent use of PCA
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