目的 通过对腹部手术后自控静脉镇痛（PCIA）不同药物配方的研究，探讨酒石酸布托啡诺与舒芬太尼用于术后PCIA临床效果。 方法 将2012年2月－8月收治的60例麻醉分级为Ⅰ～Ⅲ级需术后镇痛的腹部手术患者（均无心、肺、肝、肾、脑、内分泌疾病及过敏史）随机分成两组：酒石酸布托啡诺组（N组，n=30），舒芬太尼组（S组，n=30）。观察镇痛效果和不良反应发生率。 结果 两组镇痛效果差异无统计学意义（P＞0.05），不良反应（包括恶心、呕吐、头晕、嗜睡、皮肤瘙痒、呼吸抑制、尿潴留等），N组发生率均低于S组（P＜0.05）。 结论 酒石酸布托啡诺用于PCIA安全、有效，不良反应少。
目的 评估术后亚麻醉剂量的氯胺酮提高布托啡诺自控静脉镇痛(patient sey-controlled intravenous analgesia， PCIA）效果的可行性及应用价值。 方法 将2008年6月-2009年5月收治的68例美国麻醉师协会（ASA）分级Ⅰ~Ⅱ级的择期外科手术患者随机分为B组(0.2 mg/mL布托啡诺组）和BK组(0.2 mg/mL布托啡诺和4 mg/mL氯胺酮混合液组），每组34例。患者于手术结束后连接自控镇痛泵行自控PCIA。观察并记录拔除气管导管后及PCIA后1、4、8、12、24 h患者疼痛评分视觉模拟评分（VAS）、镇静评分、血压、心率、血氧饱和度（SPO2）、按压次数和布托啡诺消耗量，以及呼吸抑制(SPO2≤92%）、恶心呕吐、尿潴留等并发症。 结果 BK组24 h布托啡诺用量减少40%，VAS评分降低，与B组比较差异均有统计学意义(Plt;0.05）。同时VASgt;3的发生率明显减少(Plt;0.05）。镇静评分和过度镇静发生率降低，但差异无统计学意义(Pgt;0.05）。恶心呕吐的发生率两组差异无统计学意义(Pgt;0.05）。 结论 布托啡诺配伍亚麻醉剂量的氯胺酮在术后患者PCIA中能增强布托啡诺的镇痛效果，不良反应无明显增加。
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.