| 摘要: |
| 目的:评价硬膜外小剂量纳洛酮复合舒芬太尼、罗哌卡因用于老年全髋置换患者术后硬膜外自控镇痛(PCEA)的效果及安全性。方法:60例ASA Ⅰ~Ⅱ级老年全髋置换患者,随机分为2组(n=30),分别采用0.15%罗哌卡因+0.5 μg/ml舒芬太尼(C组)和0.15%罗哌卡因+0.5 μg/ml舒芬太尼+0.09 μg/（kg·ml）纳洛酮（N组）进行PCEA。双盲随访两组患者,记录镇痛开始后2、6、12、24 h视觉模拟评分(VAS),评价镇痛效果,并记录手术后恶心呕吐、皮肤瘙痒、过度镇静、呼吸抑制和低血压等不良反应的发生情况。结果:镇痛后6、12、24 h,N组VAS评分明显低于C组(P<0.01)；N组患者恶心呕吐的发生率明显低于C组(P<0.05)；两组患者其他不良反应无统计学差异；两组患者镇痛期间生命体征平稳,未发生呼吸抑制和低血压。结论:硬膜外小剂量纳洛酮可增强舒芬太尼的镇痛作用,在完善术后监测的同时小剂量纳洛酮复合舒芬太尼、罗哌卡因可安全有效地用于老年人全髋置换术后PCEA。 |
| 关键词: 老年人；舒芬太尼；阿片受体拮抗剂 纳洛酮；硬膜外镇痛；患者控制镇痛 |
| DOI：10.3724/SP.J.1008.2009.00065 |
| 投稿时间：2008-01-14修订日期：2008-06-22 |
| 基金项目: |
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| Low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement |
| NING Hui-jie,XU Hai-tao,YUAN Hong-bin*,LI Ying-ke,SHI Xue-yin |
| (Department of Anesthesiology,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China) |
| Abstract: |
| Objective:To evaluate the effect and safety of low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia (PCEA) in elderly patients undergoing total hip replacement. Methods: A total of 60 elderly patients (ASAⅠ-Ⅱ) undergoing total hip replacement were randomly assigned to two equal groups: Group C was given 0.5 μg/ml sufentanil in 0.15% ropivacaine; Group N was given the same solution with 0.09 μg/(kg·ml) naloxone. The 2 groups were followed up in a double-blinded manner: the visual analogue scale (VAS) for pain score was recorded at 2, 6, 12, and 24 h to evaluate the analgesia effect. Meanwhile, the incidences of postoperative nausea and vomiting (PONV), pruritus, sedation, respiratory depression, and hypotension were also recorded.Results: The VAS pain score in Group N was significantly lower than that in Group C at 6, 12 and 24 h (P<0.01). The incidence of PONV in Group N was significantly lower than that in Group C (P<0.05); the incidences of other opioid-induced side-effects were not significantly different between the 2 groups. During the course of analgesia, the vital signs of 2 groups were stable; no patients had respiratory depression or hypotension.Conclusion: Low-dose epidural naloxone can enhance the analgesic effect of sufentanil. With timely postoperative monitoring, low-dose naloxone combined with sufentanil and ropivacaine is safe and effective for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement. |
| Key words: aged sufentanil antagonists opioid naloxone epidural analgesia patient-controlled analgesia |
