目的 评价舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和脑电双频指数（BIS）的影响。 方法 2010年1月－2011年12月间，选择美国麻醉医师协会分级Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例，随机分为芬太尼组（A组）、舒芬太尼组(B组）和舒芬太尼+艾司洛尔组（C组）。A组用芬太尼4 μg/kg，B、C组用舒芬太尼0.6 μg/kg麻醉诱导后气管插管，机械通气；C组在气腹前加用艾司洛尔。3组均常规静脉注射咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。分别记录各组在气腹前（T1）、气腹30 s（T2）、气腹5 min（T3）、气腹15 min（T4）时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和BIS值。 结果 T1时C组收缩压、舒张压、心率、BIS值最低，各组间差异无统计学意义（P＞0.05）；T2、T3、T4时A组收缩压、舒张压、心率、BIS明显增加，B组有所上升，ⅢC组各时段变化不明显。A组与B组、B组与C组间差异有统计学意义（P＜0.05）。 结论 舒芬太尼复合艾司洛尔能更好地预防腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和抑制BIS的增加。
目的 观察右美托咪啶复合舒芬太尼用于经腹子宫全切术后患者自控静脉镇痛（PCIA）的效果。 方法 2011年3月－2012年6月选择经腹子宫全切术患者90例，年龄39～68岁，体重48～72 kg，美国麻醉医师协会分级Ⅰ～Ⅱ级。采用随机数字表法，将患者随机分为3组，每组各30例。于手术结束即刻行PCIA。对照组（C组）采用舒芬太尼150 μg+昂丹司琼12 mg；S1组采用右美托咪定200 μg+舒芬太尼100 μg+昂丹司琼12 mg；S2组采用右美托咪定200 μg+舒芬太尼150 μg+昂丹司琼12 mg。3组均用生理盐水稀释至100 mL，负荷剂量均为舒芬太尼0.1 μg/kg，静脉镇痛泵背景输注速度2 mL/h，自控给药剂量0.5 mL，锁定时间15 min。记录术后6、12、24和48 h Ramsay镇静评分和视觉模拟评分（VAS），记录不良反应发生情况和患者对术后镇痛的满意度。 结果 3组患者均能获得较好的镇痛效果。其中C组VAS评分较低，但恶心、呕吐、皮肤瘙痒发生率升高；与C组相比，Sl组和S2组Ramsay镇静评分升高，恶心、呕吐、皮肤瘙痒发生率降低，患者满意度升高。S1组患者满意度最高；S2组VAS评分最低。3组均未发生心动过缓、低血压、过度镇静和呼吸抑制。 结论 右美托咪啶可增加经腹子宫全切术患者术后舒芬太尼自控静脉镇痛的效果，提高患者满意度，降低不良反应。
【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组，术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼；B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼；C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼，观察三组患者的术后镇痛效果（视觉模拟法评分，即VAS评分）及不良反应。 结果 A组VAS评分高于B组和C组，B组VAS评分高于C组（Plt;0.05）。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异（Pgt;0.05）。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小，患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
ObjectivesTo systematically evaluate the efficacy and safety of dezocine combine with sufentanil (DS) versus sufentanil (S) for postoperative analgesia.MethodsCNKI, WanFang Data, VIP, PubMed, Wiley Online Library and ScienceDirect databases were searched online to collect randomized controlled trials (RCTs) of DS versus S for postoperative analgesia from January 2011 to July 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata13.0 software.ResultsA total of 39 RCTs were included. The results of meta-analysis showed that: DS group had higher scores on VAS at 2 h, 6 h, 12 h, 24 h and 48 h points than S group at the dezocine level of 0.2 mg/kg. At the dezocine level of 0.3 mg/kg, there were no significant differences in scores on VAS at 2 h and 4 h. However, DS group had higher scores at 6 h, 12 h, 24 h and 48 h points. At the dezocine level of 10 mg/kg, there were no significant differences in scores on VAS at each time point in both groups. DS group was superior to S group in " excellent rate” and " good rate” of the analgesic satisfaction of patients. For safety, the incidence of postoperative nausea and vomiting of DS group was lower than S group.ConclusionsThe current evidence shows that dezocine combine with sufentanil have more effects of postoperative analgesia than sufentanil alone, and its incidence of adverse reactions is lower. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
目的 观察帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的安全性和有效性及对患者满意度的影响，为提高临床无痛胃镜麻醉的安全性和舒适性提供依据。 方法 采取前瞻性随机双盲对照方法，纳入2011年8月－12月拟行无痛胃镜检查的患者120例，随机分为3组。患者于胃镜检查开始前口服利多卡因胶浆，静脉注射舒芬太尼、帕瑞昔布钠或生理盐水10 mL。检查时静脉注射异丙酚。记录患者检查过程中生命体征、异丙酚使用量、诱导时间、检查时间、苏醒时间、医师以及患者满意度、舒适度等数据。 结果 舒芬太尼组检查中各时间点平均动脉压明显低于帕瑞昔布组（P=0.029），血管活性药物用量明显高于帕瑞昔布组（P=0.036）。医师以及患者满意度舒芬太尼组和帕瑞昔布组相当，且均高于对照组（P＜0.05）。除呛咳外，帕瑞昔布组其他不良反应的发生率明显低于舒芬太尼组（P＜0.05）。 结论 实施无痛胃镜检查前15 min静脉注射帕瑞昔布钠0.6 mg/kg或舒芬太尼0.10 μg/kg均可以获得满意的麻醉效果，麻醉医师和患者及家属的满意度明显增高，且帕瑞昔布对呼吸和循环的影响更小，安全性更高。
ObjectiveTo evaluate the efficacy and safety of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia (PCIA) in patients after radical operation for abdominal tumor. MethodsBetween September 2012 and May 2013, 60 patients (aged 40-60, American Sociaty of Anesthesiologists physical statusⅠ-Ⅱ) undergoing abdominal tumor surgery and asking for PCIA pumps voluntarily were randomly divided into two groups (group D and group DF) with 30 in each group. Patients in group D were given sufentanil 0.25 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline, while in group DF, the patients received dexmedetomidine 1.5 μg/kg+ sufentanil 0.15 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline. The changes of mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), the visual analog scale (VAS), Ramsay sedation scale, Bruggrmann analgesia scale (BCS), the efficacy of postoperative analgesia and adverse effects were observed and recorded at the preoperative time (T0), and 2 (T1), 4 (T2), 8 (T3), 24 (T4) and 48 hours (T5) postoperatively. ResultsHemodynamics in group DF was more stable than that in group D (P<0.05). There were no statically significant differences in terms of VAS and BCS between the two groups at each time point (P>0.05). The Ramsay sedation scale of group DF was better than group D, and the difference was statistically significant (P<0.05). The efficient number of pressing within 48 hours in the two groups was not significantly different (P>0.05). The incidence of nausea, vomiting and drowsiness in group D was more than that of group DF (P<0.05). ConclusionDexmedetomidine combined with dezocine can provide effective postoperative analgesia with less adverse effects for patients after radical surgery of abdominal tumor, which provides higher satisfaction to the abdominal surgery patients.
ObjectivesTo systematically review the efficacy and safety of sufentanil versus fentanyl used in patient-controlled intravenous analgesia (PCIA) after cesarean section.MethodsAn online search of computerized searches of the database of MEDLINE (OVID), Web of Science, The Cochrane Central Register of Controlled Trials, PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed were conducted. Randomized controlled trials published since the inceptions of these databases until April 1st 2018, involving the comparison of sufentanil versus fentanyl for PCIA after cesarean section were included. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 19 studies were included. The results of meta-analysis showed that, compared with the fentanyl group, the sufentanil group had statistically significant lower VAS scores at 4-hour (MD=–0.99, 95%CI –1.03 to –0.95, P<0.001), 8-hour (MD=–0.30, 95%CI –0.40 to –0.21, P<0.001), 12-hour (MD=–0.54, 95%CI –0.62 to –0.46, P<0.001) and 24-hour (MD=–0.35, 95%CI –0.41 to –0.28, P<0.001); statistically significant higher Ramsay scores at 4-hour (MD=0.72, 95%CI 0.66 to 0.78, P<0.001), 8-hour (MD=0.93, 95%CI 0.86 to 1.00, P<0.001), 12-hour (MD=0.98, 95%CI 0.91 to 1.05, P<0.001), 24-hour (MD=0.07, 95%CI 0.03 to 0.11, P=0.000 5), 48-hour (MD=0.05, 95%CI 0.03 to 0.08, P<0.000 1). As for the adverse reactions, sufentanil group had lower risks of having nausea and vomiting (RR=0.25, 95%CI 0.19 to 0.31, P<0.001), pruritus (RR=0.41, 95%CI 0.30 to 0.57, P<0.001), dizziness (RR=0.27, 95%CI 0.17 to 0.44, P<0.001) and urinary retention (RR=0.35, 95%CI (0.15, 0.82), P=0.02).ConclusionsThe current evidence shows that, sufentanil has better analgesia and sedative effects, and less risks of adverse reactions for safer clinical use.
【摘要】 目的 比较舒芬太尼与等效剂量芬太尼在髋关节置换术后患者硬膜外镇痛的临床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髋关节置换术患者，随机分为两组（n=25）。芬太尼组（A组）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL；舒芬太尼组（B组），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL硬膜外镇痛。其中，A组患者于手术结束时，静脉滴注格拉司琼3 mg。持续剂量2 mL/h，单次给药量（PCA）0.5 mL/次，锁定时间15 min。观察两组的镇痛效果，恶心、呕吐次数，记录脉搏血氧饱和度、心率、呼吸的变化。 结果 镇痛泵开机后，B组各时段镇静评分，2分以上者明显多于A组，镇痛评分明显低于A组，有统计学意义（Plt;0.05），两组术后恶心、呕吐发生率都较低，组间差异无统计学意义（Pgt;0.05）。两组4、12、24 h的呼吸频率和脉搏血氧饱和度差异有统计学意义（Plt;0.05），但48 h的呼吸频率和脉搏血氧饱和度无统计学意义（Pgt;0.05）。 结论 在等效剂量下，髋关节置换术后患者硬膜外镇痛，舒芬太尼明显优于芬太尼。【Abstract】 Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement. Methods From December 2006 to September 2008, fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups, each group had 25 cases. Group A (fentanyl group): fentanyl mesylate 0.75 mg+0.894% ropivacaine 20 mL+0.9% sodium chloride solution to 100 mL; group B (sufentanil group): sufentanil 75 μg+0.894% ropivacaine mesylate 20 mL+0.9% sodium chloride solution to 100 mL epidural analgesia. Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery. Continuous dose was 2 mL/h, with the volume of single dose (PCA) 0.5 mL per time and lockout time of 15 minutes. The analgesic effect, nausea, and vomiting frequency were observed, and the pulse oxygen saturation, heart rate, and breathing changes were recorded. Results After boot analgesia, S sedation scores for each phase and pain score in group B were significantly different compared with those in group A (Plt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (Pgt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (Plt;0.05), but at 48 h the difference was not significant (Pgt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。