罗哌卡因复合吗啡或芬太尼用于术后硬膜外镇痛的观察和比较

Comparison of efficacy between morphine and fentanyl used in combination with ropivacaine for postoperative continuous epidural analgesia

目的观察和比较罗哌卡因复合吗啡或芬太尼用于术后硬膜外持续镇痛(CEA)的临床效果和并发症。方法60例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级的下腹部手术患者随机分为RM、RF两组,每组30例。手术结束时,RM组硬膜外注射负荷量0.2%罗哌卡因+1mg吗啡共5ml,然后接镇痛泵持续输注0.2%罗哌卡因和0.005%吗啡;RF组硬膜外注射负荷量为0.2%罗哌卡因+0.01mg芬太尼共5ml,然后接镇痛泵持续输注0.2%罗哌卡因和1ug/ml芬太尼;2组镇痛泵流速均为2ml/h;记录使用镇痛泵后30min及1h、4h、8h、24h、48h各时间VAS评分、改良Bromage分级,并观察恶心呕吐、尿潴留、出汗、皮肤瘙痒、呼吸抑制等并发症的发生情况。结果使用镇痛泵后各时段VAS评分、改良Bromage分级2组间无明显差异(P>0.05),RM组恶心呕吐、尿潴留发生率明显高于RF组(P<0.05)。结论罗哌卡因复合吗啡或芬太尼用于术后CEA均可取得良好的镇痛效果,而复合芬太尼并发症较少,更为理想。

Objective To compare the clinical effect and complication of 0.2%ropivacaine combined with morphine and combined with fentanyl for postoperative continuous epidural analgesia (CEA). Methods 60 patients of ASA gradeⅠ～Ⅱwho underwent abdomen operation were randomized into group RM and group RF (30 patients in each group). Group RM was given a 5ml bolus of 0.2%ropivacaine plus 1 mg morphine,followed by a continuous infusion of 0.2%ropivacaine plus 0.005%morphine at a speed of 2 ml/h. To group RF ,fentanyl was given instead of morphine (0.01mg in bolus and 1μg/ml for the continuous infusion ). The complications of nausea and vomiting,pruritus,urine retention and respiratory depression were noticed. The analgesic and paralytic effects expressed in VAS and modified bromage degrees respectively,were recorded 30min 1h,4h,8h,24h and 48h after operation. Results There were no significant difference between group RM and group RF in VAS scales and modified Bromage degree,but the incidences of nausea and vomiting and urinary retention in group RM were obviously higher than in group RF (P<0.05). Conclusion 0.2%ropivicaine combined with morphine and fentanyl could be safely and effectively used for postoperative analgesia. Because of the lower incidence of complications,the use of ropivacaine and fentanyl will be more satisfactory.