术后罗哌卡因芬太尼硬膜外镇痛和对肺功能的影响

A COMPARISON OF THORACIC EPIDURAL ROPIVACAINE WITH FENTANYL INFUSION VERSUS PATIENT-CONTROLLED ANALGESIA WITH MORPHINE FOR POSTTHORACOTOMY PAIN AND THEIR EFFCT ON PULMONARY FUNCTION

目的 :评估开胸术后罗哌卡因芬太尼硬膜外镇痛效果和对肺功能的影响。方法 :4 0例择期行肺叶切除术病人 (ASAI～II)随机分为两组 :罗哌组 (n =2 0 )给予 0 .2 %罗哌卡因 (复合 2 μg/ml芬太尼 )胸椎硬膜外连续输注 ,4ml/h ;吗啡组 (n =2 0 )给予静脉吗啡自控镇痛。采用 10cm视觉模拟评分尺评估术后 1日、2日静息和咳嗽疼痛评分 ,测量术前和术后 1日、2日肺功能 (用力肺活量FVC、1秒用力呼出量FEV1、呼气峰流速PEF)和血气 ,记录副作用、肺部并发症和术后住院日。结果 :(1)术后 1日、2日静息和咳嗽疼痛评分罗哌组显著低于吗啡组 (P <0 .0 1) ;(2 )术后 1日、2日罗哌组肺功能显著优于吗啡组 (P <0 .0 5 ) ,罗哌组氧分压显著高于吗啡组 (P <0 .0 1) ;(3)吗啡组术后恶心发生率显著高于罗哌组 (P <0 .0 5 ) ,其它副作用无显著差异 ;(4)均无肺部合并症发生 ,术后住院日无显著差异。结论 :0 .2 %罗哌卡因 (复合 2 μg/ml芬太尼 )可安全有效用于开胸术后硬膜外镇痛 ,并改善肺功能。

Objective:To assess the effects of continuous thoracic epidural ropivacaine with fentanyl on postthoractomy pain and pulmonary function. Methods:Forty patients (ASA Ⅰ～Ⅱ)undergoing elective pneumonecotomy were randomly divided into two groups: Group R (n=20) received continuous thoracic epidural 0.2% ropivacaine with 2μg/ml fentanyl infusion at a rate of 4ml/h; Group M(n=20) received patient-controlled analgesia (PCA) with intravenous morphine. Analgesia was tested using a visual analog pain scale (VAS) (0～10cm). Pulmonary function and arterial blood gas analysis were measured on 1st and 2 nd day postoperatively. The incidence of side effects, pulmonary complications and the length of hospital stay were also recorded. Results: (1) The pain scores were significantly lower in group R at rest and on coughing than group M on 1st and 2nd day postoperatively ( P <0.01). (2) Pulmonary function was better preserved in group R than group M on 1st and 2nd day postoperatively ( P <0.05). PaO 2 was higher in group R than group M on 1st and 2nd day postoperatively ( P <0.01). (3) The group M was associated with significantly increased incidence of postoperative nausea( P <0.05). (4) No pulmonary complications occurred and the length of hospital stay was similar in both groups. Conclusions: Continuous epidural analgesia with the combination of ropivacaine and fentanyl is a safe and effective method for pain relief. It provides more improvement of pulmonary function than morphine.