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目的探讨小剂量舒芬太尼鞘内预注联合硬膜外自控镇痛(PCEA)用于经腹子宫全切术后镇痛的临床疗效。方法 90例行经腹子宫全切术患者为研究对象,采用随机数字法将患者分为A组、B组和对照组,各30例。患者均行腰麻硬膜外联合麻醉,其中对照组采用鞘内注入布比卡因治疗,A组在对照组基础上鞘内预注10μg舒芬太尼治疗,B组在对照组基础上鞘内预注20μg舒芬太尼治疗。观察用药期间三组患者不良反应发生情况,采用视觉模拟评分法(VAS)评价各时间点的疼痛程度。结果 A组、B组患者术后2、12、24、48 h的VAS评分均较同期对照组明显降低;A组同期VAS评分均优于B组;差异均具有统计学意义(P<0.05)。对照组与A组不良反应发生率比较差异无统计学有意义(P>0.05)。A组不良反应发生率(20.0%)明显低于B组(53.3%),差异具有统计学意义(P<0.05)。结论舒芬太尼鞘内预注联合PCEA能有效减轻经腹子宫全切术后疼痛,但需要注意大剂量使用会造成患者过度镇静及恶心呕吐等不良反应,临床中应合理使用。
Objective To investigate the clinical effect of low dose sufentanil intrathecal injection combined with epidural analgesia (PCEA) for post-abdominal hysterectomy pain relief. Methods Totally 90 patients undergoing total abdominal hysterectomy were divided into A group, B group and control group, with 30 cases in each group by random number method. Patients underwent spinal anesthesia combined epidural anesthesia, the control group received intrathecal bupivacaine treatment, A group in the control group on the basis of intrathecal pre-injection of sufentanil 10μg, B group in the control group on the basis of sheath 20μg Sufentanil within the pre-injection. The incidence of adverse reactions was observed in three groups during the treatment period. Visual analog scale (VAS) was used to evaluate the degree of pain at each time point. Results The VAS scores at 2, 12, 24 and 48 h after operation in group A and group B were significantly lower than those in control group. The VAS scores in group A were significantly higher than those in group B at the same period (P <0.05) . There was no significant difference in the incidence of adverse reactions between the control group and the A group (P> 0.05). The incidence of adverse reactions in group A (20.0%) was significantly lower than that in group B (53.3%), the difference was statistically significant (P <0.05). Conclusion Sufentanil intrathecal injection combined with PCEA can effectively reduce the pain after abdominal hysterectomy, but need to pay attention to high-dose use will cause patients with over-sedation and nausea and vomiting and other adverse reactions, should be used clinically.