吗啡布比卡因硬膜外镇痛用于子宫切除病人的研究

Study on the Application of Morphine and Bupivacaine in Gynecological Surgeries to Ease Pain

目的观察不同剂量吗啡布比卡因配伍硬膜外持续泵注用于子宫全切术病人术后镇痛中的效果和安全性,以探讨最佳的药物配方。方法60例ASAI-Ⅱ级择期子宫切除术病人,随机分为A、B、C3组,每组20例病人。A组吗啡10mg/100ml,0.125%布比卡因;B组吗啡5mg/100ml,0.125%布比卡因;C组吗啡5mg/100m1,0.075%布比卡因。3组术中均在硬膜外麻醉下完成手术,手术结束后给负荷量4～6ml,接上海“怡新”自控镇痛泵行PCEA镇痛。术后24、48h采用视觉模似评分法(VAS)评估静息及翻身活动时的镇痛效果,记录镇痛过程中恶心、呕吐、皮肤瘙痒等副作用的发生情况。结果①术后24、48h静息疼痛VAS评分3组间差异无显著性,翻身活动疼痛VAS评分A、B两组间差异无显著性,C组明显高于A、B两组;②3组术后24、48hBP、HR、SpO2均平稳;③恶心、呕吐、皮肤瘙痒的发生A组明显多于B、C两组,B、C两组间差异无显著性。结论吗啡5mg/100ml,0.125%布比卡因用于子宫切除术病人PCEA镇痛,能获得满意的镇痛效果,且恶心、呕吐、皮肤瘙痒等副作用发生率低。

To observe the effect and safety of using different doses of morphine and bupivacaine in gynecological surgeries to ease pain and explore the best medicine recipe. 60 patients of class ASAI-II who were to undergo abdominal hysterectomy were randomly divided into 3 groups (group A, B and C). Group A received 10 mg/100 ml of morphine and 0.125% of bupivacaine; group B received 5 mg/100 ml of morphine and 0.125% of bupivacaine; group C received 5 mg/100 ml of morphine and 0.0 75% of bupivacaine. All the groups underwent the operation under the condition of epidural anesthesia and received 5mg/100ml of morphine after surgery. The pain-easing effect was observed using VAS method when the patients were calm or turning body, all side effects like sickness, vomiting and skin itch were carefully recorded. There was no significant difference between the 3 groups in the VAS grades while the patients were in calm 24 hours and 48 hours after operation, neither between group A and group B while the patients were turning body, but the grade of group C was significantly higher than that of group A and B. ii. The BP, HR and SpO 2 of the 3 group were all stable. iii. The occurrence rate of side effects like sickness, vomiting and skin itch in group A was significantly higher that in group B and C, but no significant difference was found between group B and C. [Conclusion] Application of 5 mg/100 ml of morphine and 0.125% of bupivacaine has a satisfactory pain-easing effect and it may lead to low occurrence of side effects.