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目的观察舒芬太尼用于腹腔镜宫颈癌根治术后靶控输注(TCI)镇痛的临床疗效及安全性。方法美国麻醉医师协会麻醉分级Ⅰ~Ⅱ级择期进行腹腔镜宫颈癌根治术的患者36例随机分2组。试验组(靶控镇痛)18例,给予舒芬太尼初始血浆靶浓度0.1 ng·mL~(-1),疼痛时上调靶浓度0.01 ng·mL~(-1),锁定15min。对照组(患者自控镇痛)18例,给予舒芬太尼背景剂量3μg·h~(-1),患者静脉自控镇痛冲击剂量每次3μg,锁定15 min。于镇痛前(T_0)及镇痛后0.5(T_1),1(T_2),1.5(T_3),2(T_4),4(T_5),8(T_6),12(T_7)和16 h(T_8),记录生命体征、Prince-Henry评分、Ramsay评分、舒芬太尼术后镇痛总剂量、患者自主要求镇痛次数和不良反应发生情况,并在T_0、T_2、T_5、T_6进行血气分析。TIVAtrainer软件拟合计算舒芬太尼药代动力学曲线。结果 2组平均动脉压、心率、呼吸频率、脉搏血氧饱和度和血气指标均在正常范围内。试验组在T_1、T_2、T_3、T_6、T_7、T_8时Prince-Henry评分显著低于对照组(P<0.05),2组Ramsay评分差异无统计学意义(P>0.05)。对照组自主镇痛次数多于试验组。试验组血浆靶浓度在T_1、T_5、T_6、T_7、T_8显著高于对照组(P<0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论舒芬太尼血浆靶浓度0.1 ng·mL~(-1)行术后靶控镇痛,与患者静脉自控镇痛比较,镇痛疗效更佳且不增加不良反应发生率。
Objective To observe the clinical efficacy and safety of sufentanil for target-controlled infusion (TCI) analgesia after laparoscopic radical hysterectomy for cervical cancer. Methods The American Society of Anesthesiologists anesthesia grade Ⅰ ~ Ⅱ elective radical laparoscopic radical cystectomy in 36 patients were randomly divided into two groups. Twenty-eight patients in the test group (target controlled analgesia) received the initial target plasma concentration of 0.1 ng · mL -1 of sufentanil and the target concentration of 0.01 ng · mL -1 in pain. Control group (patient-controlled analgesia) in 18 cases, given sufentanil background dose of 3μg · h -1, patients with intravenous analgesic and shock dose of 3μg, locked for 15 min. (T_6), 12 (T_7) and 16 h (T_8) before the analgesia (T_0) and 0.5 (T_1) ), Vital signs, Prince-Henry score, Ramsay score, total sufentanil postoperative analgesia dose, the number of analgesic patients and the incidence of adverse reactions were recorded. Blood gas analysis was performed on T 0, T 2, T 5 and T 6. TIVAtrainer software fitting sufentanil pharmacokinetic curve. Results The mean arterial pressure, heart rate, respiratory rate, pulse oximetry and blood gas index in the two groups were within the normal range. The Prince-Henry score of T_1, T_2, T_3, T_6, T_7 and T_8 in the experimental group was significantly lower than that in the control group (P <0.05). There was no significant difference in Ramsay scores between the two groups (P> 0.05). The control group had more spontaneous analgesia than the experimental group. The plasma concentrations of T_1, T_5, T_6, T_7 and T_8 in the experimental group were significantly higher than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Sufentanil has a target-controlled analgesia of 0.1 ng · mL ~ (-1) at the plasma target concentration. Compared with intravenous controlled analgesia, sufentanil has better analgesic effect and does not increase the incidence of adverse reactions.