CAJ | 학술논문

目的比较不同浓度舒芬太尼配伍左布比卡因用于剖宫产术后病人自控硬膜外镇痛(PCEA)的效果.方法择期拟行剖宫产术的足月、单胎产妇90例,年龄22 ～ 35岁,体重60～ 85 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组(n=30):0.125％左布比卡因配伍0.4、0.6和0.8μg/ml舒芬太尼组(Ⅰ组-Ⅲ组).术后分别行PCEA 48 h,负荷剂量5ml,持续输注剂量2 ml/h,单次给药剂量2ml,锁定时间15 min.采用视觉模拟评分(VAS评分)法评价术后48 h内疼痛程度,VAS评分≥4分时进行补救镇痛,记为自控镇痛失败.于术前、术后24和48 h时采集静脉血样,采用放射免疫分析法测定血清泌乳素浓度,采用改良Bromage评分法评价下肢运动阻滞程度,记录各组总按压次数和初乳时间,记录恶心、呕吐、瘙痒、嗜睡、呼吸抑制、心动过缓、低血压及尿潴留的发生情况.结果与Ⅰ组比较,Ⅱ组和Ⅲ组总按压次数减少,自控镇痛失败率降低,初乳时间缩短,术后24和48 h时血清泌乳素浓度升高,Ⅲ组恶心呕吐及心动过缓发生率升高(P＜0.05)；与Ⅱ组比较,Ⅲ组总按压次数、自控镇痛失败率、初乳时间、术后24和48 h时血清泌乳素浓度差异无统计学意义(P＞0.05),恶心呕吐及心动过缓等不良反应发生率升高(P＜0.05)；3组改良Bromage评分比较差异无统计学意义(P＞0.05).结论舒芬太尼配伍0.125％左布比卡因用于剖宫产术后PCEA时适宜浓度为0.6μg/ml.
목적 비교불동농도서분태니배오좌포비잡인용우부궁산술후병인자공경막외진통(PCEA)적효과.방법 택기의행부궁산술적족월、단태산부90례,년령22 ～ 35세,체중60～ 85 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위3조(n=30):0.125％좌포비잡인배오0.4、0.6화0.8μg/ml서분태니조(Ⅰ조-Ⅲ조).술후분별행PCEA 48 h,부하제량5ml,지속수주제량2 ml/h,단차급약제량2ml,쇄정시간15 min.채용시각모의평분(VAS평분)법평개술후48 h내동통정도,VAS평분≥4분시진행보구진통,기위자공진통실패.우술전、술후24화48 h시채집정맥혈양,채용방사면역분석법측정혈청비유소농도,채용개량Bromage평분법평개하지운동조체정도,기록각조총안압차수화초유시간,기록악심、구토、소양、기수、호흡억제、심동과완、저혈압급뇨저류적발생정황.결과 여Ⅰ조비교,Ⅱ조화Ⅲ조총안압차수감소,자공진통실패솔강저,초유시간축단,술후24화48 h시혈청비유소농도승고,Ⅲ조악심구토급심동과완발생솔승고(P＜0.05)；여Ⅱ조비교,Ⅲ조총안압차수、자공진통실패솔、초유시간、술후24화48 h시혈청비유소농도차이무통계학의의(P＞0.05),악심구토급심동과완등불량반응발생솔승고(P＜0.05)；3조개량Bromage평분비교차이무통계학의의(P＞0.05).결론 서분태니배오0.125％좌포비잡인용우부궁산술후PCEA시괄의농도위0.6μg/ml.
Objective To compare the efficacy of patient-controlled epidural analgesia (PCEA) with different concentrations of sufentanil plus levobupivacaine after caesarean section.Methods Ninety ASA Ⅰ or Ⅱ nulliparous patients who were at full term with a singleton fetus,aged 22-35 yr,weighing 60-85 kg,undergoing elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =30each):0.125％ levobupivacaine plus sufentanil 0.4,0.6 and 0.8μg/ml groups (groups Ⅰ,Ⅱ and Ⅲ).The patients received 48 h of PCEA after operation.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 2 ml with a lockout-interval of 15 min after a loading dose of 5 ml.VAS score was used to assess the intensity of pain (0 =no pain,10 =worst pain).VAS score ≤ 3 was considered as effective analgesia.VAS score ≥4 was considered as failure of analgesia,and the rescue analgesic was given.Venous blood samples were taken before operation and at 24 and 48 h after operation to detect the serum prolactin (PRL) concentration using radioimmunoassay.The degree of motor block of lower extremities was assessed and scored using modified Bromage scale.Maternal colostrum time,the number of attempts,and adverse effects including nausea and vomiting,pruritus,somnolence,respiratory depression,bradycardia,hypotension and urinary retention were recorded after operation.Results Compared with group Ⅰ,the number of attempts and rate of failure of analgesia were significantly decreased,the maternal colostrum time was shortened,and the serum PRL concentration at 24 and 48 h after operation was significantly increased in groups Ⅱ and Ⅲ,and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,no significant change was found in the number of attempts,rate of failure of analgesia,maternal colostrum time,and serum PRL concentration at 24 and 48 h after operation (P ＞ 0.05),and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ (P ＜ 0.05).There was no significant difference in the modified Bromage scores among the three groups (P ＞ 0.05).Conclusion When sufentanil plus 0.125 ％ levobupivacaine are used for PCEA,the recommonded concentration of sufentanil is 0.6 μg/ml.