罗比卡因复合液对儿童术后自控硬膜外镇痛效果及下肢运动功能的影响

Effect of ropivacaine mixture on patient controlled epidural analgesia and moto r function of low limbs in postoperative children

目的:研究低浓度罗比卡因复合小剂量芬太尼、咪唑安定等用于儿童术后自控硬膜外镇痛PCEA的镇痛效果及下肢运动功能恢复情况。()方法:2003-08/2004-07郑州大学第一附属医院泌尿外科ASAⅠ～Ⅱ级,年龄4～8岁,择期先天性尿道下裂修复手术后PCEA男性病儿60例,随机分成罗比卡因组镇痛液1g/L罗比卡因+芬太尼0.001g/L+咪唑(安定0.07mg/kg+地塞米松5mg+昂丹司琼4mg)30例和布比卡因组(1g/L布比卡因复合相同药物30例。观察两组镇痛、镇静效果,循环、)呼吸、血氧饱和度,下肢运动,胃肠功能恢复时间及副作用。结果:两组的镇痛、镇静效果均良好,总PCEA次数、循环、呼吸、血氧饱和度,手术前后及组间差异无显著性意义(P>0.05);Bromage评分罗比卡因组为(0.26±0.43)分,布比卡因组为(0.38±0.51)分,两组均无2分病例,评分差异无显著性意义P>0.05);罗比卡因组肠蠕动恢复(犤(15.69±6.83)h犦较布比卡因组犤(20.58±7.10)h犦快,组间差异有显著性意义(t=2.719,P<0.01)。结论:小儿术后低浓度罗比卡因复合液PCEA,镇痛效果好,对下肢运动功能影响小,较布比卡因胃肠功能恢复快,是较好的小儿术后镇痛康复方法。

AIM:To investigate the analgesic efficacy of low dose ropivacaine combined wi th fentanvl or midazolam,etc.during patient controlled epidural analgesia(PCEA) in postoperative children and evaluate the recovery of motor function of lower limbs. METHODS:From August 2003 to July 2004,60 PCEA male children,aged 4 to 8 years, in ASA gradeⅠto Ⅱundergoing hypospadias repair surgery were selected from Depa rtment of Urinary Surgery in the First Affiliated Hospital of Zhengzhou Universi ty.They were randomly divided into two groups of 30 patients each:ropivacaine gr oup and bupivacaine group.In ropivacaine group,PCEA mixture consisting of 1 g/L ropivacaine combined with 0.001 g/L fentanvl,0.07 mg/kg midazolam,5 mg dexametha sone and 4 mg ondansetron was used.In bupivacaine group,1 g/L bupivacaine combin ed with the same drugs were used.The visual analogue scores for pain(VAS),analge sic effects,sedation scores,circulation,respiratory function,arterial oxygen sat uration(SpO2),movement of lower limbs,time for recovery of gastrointestinal func tion and side effects were observed or recorded. RESULTS:Postoperative analgesic and sedative effects were satisfactory in both two groups.There was no difference in the total times of PCEA,circulation,respi ration,SpO2 in the inter group comparison,or intra group comparison of pre an d post operation(P >0.05).The modified bromage score was (0.26±0.43) points in ropivacaine group and (0.38±0.51) points in bupivacaine group,but no cases of 2 points were found in the two groups,with insignificant difference between them (P >0.05).The time for vermiculation of patients in ropivacaine group[(15.69±6. 83) hours] was significantly shorter than that in bupivacaine group[(20.58±7.10 ) hours](t=2.719,P< 0.01). CONCLUSION:Pediatric postoperative analgesia by PCEA combined with low dose r opivacaine is more effective,has less impact on motor function of lower limbs,an d shortens the time for the recovery of gastrointestinal function,as compared th at with bupivacaine,so it is one of the ideal techniques for the pediatric posto perative analgesia.