妇科手术后硬膜外不同镇痛方法的临床比较

Clinical Comparison of Different Analgesic Measures After an Epidural Anaesthesia in Gynecology

目的：比较探讨妇科术后最佳的硬膜外镇痛方法及药物配方。方法：选择妇科手术１００例分为 Ａ、Ｂ、Ｃ、Ｄ组。Ａ组（３０例）：单次注入硬膜外腔吗啡 ３ｍｇ。Ｂ、Ｃ、Ｄ三组持续泵入长效局部麻醉药布比卡因和阿片类药物。Ｂ组（３０例）、Ｃ组（１０例）：泵入０．２％布比卡因２６０ｍｌ，内含分太尼０．３ｍｇ，氟哌啶５ｍｇ。其中Ｂ组以５ｍｌ／ｈ速度泵入，Ｃ组选用２ｍｌ／ｈ速度。Ｄ组（３０例）：采用５ｍｌ／ｈ速度泵入０．ｌ％布比卡因２６０ｍｌ，内含分太尼０．６ｍｇ，氟哌啶１０ｍｇ。比较各组间术后４、８、１２、１６、２０、２４、４８ｈ七个时间点的镇痛效果，并发症发生率。结果：Ａ组 １－２级镇痛时间为２４．８ｈ，并发症发生率低。Ｂ、Ｄ组的镇痛效果优于Ｃ组，且Ｂ、Ｄ两组间无明显差异，但Ｄ组并发症发生率明显高于Ｂ组。Ｃ组镇痛效果最差，并发症发生率最低。结论：如果手术手小，创伤小，术后疼痛不严重的病人选用次硬膜外腔注入吗啡３ｍｇ的方法为宜。手术大，创伤重，术后疼痛严重的病人选用０．２％布比卡因２６０ｍｌ，内含芬太尼０．３ｍｇ，氟哌啶５ｍｇ，以５ｍｌ／ｈ速度持续泵入的镇痛方法为宜。

Objectives: To compare the effects of different analgesic measures after an epidural anaesthesia and then to select the best analgesic method and the combination of analgesic agents. Methods: 100 cases who accepted a gynecological operation were randomly selected as group A, B, C and D. Group A (30 cases) was given 3 mg of morphine as the analgesic agent while group B, C and D were given opium and bupivacaine instead. There are 30 and 10 cases in Croup B and C in which 0. 20% of bupivacaine with the combination of fentanyl (0. 3 mg) and droperidol (5 mg) is pump into the ex- tradural cavity. The pumping speed is 5 ml per hour (5ml/h) in Group B while 2ml per hour (2ml/h) in Group C. There are 30 cases in Group D in which 0. 1% of bupivacaine (260 ml with the combination of 0. 6 mg of fentanyl and 10 mg of droperidol) with the speed of 5 ml per hour (5ml/h) is pumped into the extradural cavity. The analgesic effect and the mortality a few hours (4, 8, 12, 16, 20, 24 and 48) after the operation were observed and compared. Results: The effective time of grade 1 to 2 of analgesia is 24. 8 hours in Group A with a very low occurrence of complications. The analgesic effects in Group B and D are much better than in Group C with no significant difference between Group B and D. The incidence of complications in Group D, however, is higher than in Group B. The analgesic effect is the worst in Group C with the highest incidence of complications. Conclusion: A single injection of morphine into the ex- tradural cavity is a suggested analgesic way to the patients who accepted a relatively small gynecological operation without much wound. To the patients who accepted a big operation with much wound, 0. 2% of bupicaine (260 ml with the combination of 0. 3 mg of fentanyl and 5 mg of droperidol) with the speed of 5 ml/h could be continuously pumped into the extradural cavity, which can get a better analgesic effect.