【作者】 张宏利； 肖旺频； 周清河；

【机构】 浙江省嘉兴市第二医院麻醉科；

【摘要】 目的探讨不同剂量舒芬太尼患者自控皮下镇痛（PCSA）在胃癌根治术后镇痛效果的安全性和有效性。方法胃癌根治术后患者60例,ASAⅠ～Ⅱ级,,年龄40～68岁,体重50～86kg。术毕分三组,A组术后按需肌注杜非合剂;B组舒芬太尼3.0μg/kg+2%盐酸利多卡因200mg+生理盐水总100ml;C组舒芬太尼4.0μg/kg+2%盐酸利多卡因200mg+生理盐水总量100ml。分别于术后3、8、24、48及72h观察,并比较休息、咳嗽时的疼痛视觉模拟（VASr/VASc）评分及Ramsay评分、肛门排气时间、总体满意度评分;生命体征:SBP、DBP、HR、SPO₂;并发症:呼吸抑制、恶心呕吐、皮肤瘙痒的发生率。结果 VAS（休息/咳嗽）评分在术后72小时C组显著低于A和B组（P<0.05）;术后镇痛生命体征平稳,Ramsay评分、肛门排气时间、呼吸抑制、恶心呕吐、皮肤瘙痒发生率组间比较差异无统计学意义（P>0.05）;总体镇痛满意度评分C组显著高于A和B组（P<0.05）。结论 4.0μg/kg舒芬太尼PCSA在胃癌根治术后镇痛效果确切,副反应少且对胃肠功能的恢复影响小。更多还原

【Abstract】 Objection To evaluate the safety and efficacy of several different dosages of sufentanil for patient-controlled subcutaneous analgesia after gastric carcinectomy.Methods Sixty ASAⅠorⅡpatients aged 40⁶8yr weighing 50⁸6kg undergoing gastric carcinectomy were allocated into 3 groups of 20 patients each.According to demanding for musle-inject misture Pethidine and Promethazine in A groups,B groups were received PCSA with sufentanil 3.0μg/kg diluted with normal saline 100ml and C groups were received PCSA with sufentanil 4.0μg/kg diluted with normal saline 100ml.VASr and VASc which were used to assess analgesia at rest and cough at 3,8,24,48 and 72h after surgery.The signs including SBP、DBP、HR、SPO₂and side effects （respiratory depression,nausea,omiting and pruritus） were recored.Results During the 8 to 72 hours after gastric vcarcinectomy,the VASr and VASc scores in groups C were significantly lower than those in groups A and B（P<0.05）.The vital signs were stable.Ramsay scores,anal exhaust time and the incidence of side-effects was not significantly different.Total satisfaction scores in groups C were significantly higher than those in groups A and B（P<0.05）.Conclusion Analgesia effect of 4.0μg/kg sufentanil for patient-controlled subcutaneous analgesia after gastric carcinectomy was better,side-effects few and recover of stomach- intestine function influenced few.更多还原