舒芬太尼复合吗啡硬膜外术后镇痛的最佳剂量配伍

目的：观察腹式子宫全切术后硬膜外镇痛应用舒芬太尼复合吗啡时两种药物不同剂量的镇痛效果和不良反应,以寻找其最佳剂量配伍。方法：选择90例美国麻醉医师协会（ASA）标准Ⅰ-Ⅱ级、年龄20-60岁拟行腹式子宫全切术的病人,均实施腰硬联合麻醉。随机分成3组,每组30例：Ⅰ组：舒芬太尼10μg＋吗啡2 mg＋氟哌利多1 mg＋1%罗哌卡因20 mg;Ⅱ组：舒芬太尼15μg＋吗啡1.5 mg＋氟哌利多1 mg＋1%罗哌卡因20 mg;Ⅲ组：舒芬太尼20μg＋吗啡1 mg＋氟哌利多1 mg＋1%罗哌卡因20mg。术中监测生命体征,记录术后24小时内的镇痛效果、不良反应及辅助镇痛药物的使用情况。镇痛效果评价采用视觉模拟评分（visual analogue scale,VAS）标准。结果：2组各个时间点VAS评分均明显低于1组（P〈0.05）,在术后6 h,8 h,12 h,18 h,24 h与3组有统计学差异（P〈0.05）,3组在2 h,4 h,6 h的VAS评分低于1组（P〈0.05）;2组恶心评分与3组相比明显较低（P〈0.05）,其他不良反应三组间没有统计学差异;各组患者在术后24h内辅助镇痛药物使用情况比较无统计学差异（P〉0.05）。结论：舒芬太尼15μg复合吗啡1.5 mg用于腹式子宫全切术后硬膜外镇痛效果优于其他常用剂量配伍,镇痛效果平稳确切且不良反应少,具有临床应用价值。

The Optimal Compatibility Dosage of Sufentanil-Morphine Combination with Epidural Postoperative Analgesia

Objective： To observe the postoperative analgesic effect and adverse effects with different doses of sufentanil and mor- phine combination in patients undergoing abdominal hysterectomy surgery and find out the optimal compatibility dosage. Methods： Ninety ASA I - II patients aged 20-60 years, undergoing the abdominal hysterectomy surgery were randomly divided into three ＇groups, 30 in each. All patients received combined spinal and epidural anesthesia. In group I patients received sufentanil 10 μg and morphine 2 mg plus droperidol 1 mg and 1% ropivacaine 20 m.g; In group II patients received sufentanil 15 μg and morphine 1.5 mg plus droperidol 1 mg and 1% ropivacaine 20 nag and in group III patients were given sufentanil 20 μg and morphine 1 mg plus droperidol 1 mg and 1% ropi- vacaine 20 mg. Postoperative pain was recorded at 2 h, 4 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesic effects were estimated by Visual Analogue Scale （VAS）. Additional analgesics and adverse effects such as sedation, nausea and vomiting were recorded in the first postoperative 24 h. Results： The VAS scores at hours 2,4,6,8,12,18,24 after operation were significantly lower in group II （P〈0.05） and VAS scores at postoperative time 2 h,4 h,6 h were significantly lower in group III than group I （P〈0.05）. There were no differences in additional analgesics using and the incidence of sedation in the three groups but comparing with patients in group III, patients in group I and group II had lower incidence of nausea and vomiting（P〈0.05）. Conclusion： Receiving epidural sufentanil 15 μg and morphine 1.5 mg can provide stable and satisfying postoperative analgesia in patients undergoing the abdominal hysterectomy surgery. Otherwise the dose of sufentanil-morphine combination has lower incidence of adverse effects.