硬膜外持续泵注吗啡与布比卡因用于术后镇痛600例效果观察

Effect of morphine combined with bupicaine on postoperative analgesia by continuous epidural infusion:an observation of 600 cases

目的评价硬膜外持续泵注吗啡与布比卡因用于术后镇痛的效果及安全性。方法选择ASAⅠ-Ⅱ级择期行腹部或下肢手术患者600例,相应椎间隙穿刺行硬膜外麻醉,术毕留置硬膜外导管接镇痛泵,其内含复合液100ml(吗啡4mg+布比卡因100mg+氟哌利多2.5mg+东莨菪碱0.3mg+生理盐水),以2ml/h持续恒速注入,观察镇痛效果及不良反应。结果术后镇痛效果优良544例(90.7%),可36例(6%),差20例(3.3%),无呼吸抑制及硬膜外腔感染等严重并发症发生,恶心、呕吐、皮肤瘙痒、尿潴留、低血压等一般副作用发生率较低。结论小剂量吗啡合用低浓度布比卡因加入适量辅助药硬膜外持续恒速注入是术后有效镇痛方法之一。

Objective To evaluate the effect and safety of the application of morphine combined with bupicaine for continuous epidural infusion in postoperative analgesia. Methods A total of 600 patients with selective abdominal and inferior extremeties operation in ASA stagesⅠ-Ⅱ, accepted continuous epidural anaesthesia (CEA). An analgesia pump that contained 100 ml of compound solution (4 mg morphine, 100 mg 100 mg bupicaine, 2.5 mg droperidol, 0.3 mg scopolamine and 0.9% NS) connected with an epidual tube by continuous infusion with a constant speed of 2 ml/h. The effect of analgesia and adverse reaction were observed. Results The effect of analgesia was divided into three groups: excellent (544 cases, 90.7%), good (36 cases,6%), and poor (20 cases, 3.3%). Severe complications such as respiratory depression and epidual space infection were not observed, and the side effects such as nausea and vomiting, uroschesis, itch of skin and hypotension were less commonly observed. Conclusions The application of low-dose morphine combined with bupicaine and adjunctive drugs by continuous epidural infusion is an effective approach for postoperative analgesia.