左旋布比卡因、罗哌卡因和布比卡因术后硬膜外镇痛的临床效应比较

A Comparison Study of Epidural Analgesia with Levobupivacaine, Ropivacaine or Bupivacaine after Gynecology Operation

目的:比较左旋布比卡因(LBVP)、罗哌卡因(ROP)和布比卡因(BUP)用于开腹妇科手术后持续硬膜外输注镇痛的临床效应。方法:90例择期妇科手术病人随机分为LBUP组、ROP组和BUP组,每组30例。手术结束采用持续硬膜外输注镇痛,LBUP组采用0.15%左旋布比卡因加吗啡0.1mg/ml,ROP组采用0.2%罗哌卡因加吗啡0.1mg/ml,BUP组采用0.15%布比卡因加吗啡0.1mg/ml,输注速度均为2ml/h。观察术后48h内的VAS疼痛评分、患者对镇痛治疗总体印象评分、改良Bromage评分、术后活动能力及不良反应的发生情况。结果:三组病人在术后5个时段VAS疼痛评分、镇痛结束时对疼痛的总体评估、镇痛后4h改良Bromage评分及不良反应发生情况,各组间比较并无显著性差异(P>0.05);镇痛8h后LBUP组及BUP组分别有2例病人Bromage评分为2,至镇痛后16h恢复;术后24hROP组有21例(70%)的病人可以短时间行走,而LBUP组及BUP组分别只有12例(40%)及11例(36.7%),有显著性差异(χ2=5.45,χ2=4.34,P<0.05)。结论:0.15%左旋布比卡因、0.2%罗哌卡因与0.15%布比卡因用于开腹妇科手术后持续硬膜外输注镇痛,均可获得满意的镇痛效果,但0.2%罗哌卡因较0.15%左旋布比卡因及0.15%布比卡因术后活动能力恢复早。

Objective:To research the efficacy of epidural analgesia with levobupivacaine, ropivacaine or bupivacaine after gynecology operations. Methods: 90 ASAⅠ-Ⅱ patients undergoing gynecology operation under epidural analgesia were randomly divided into three groups, 30 cases in each groups. After operation, patients in group LBUP were given continuous epidural infusion at a rate of 2ml/ml with 0.15% levobupivacaine combined with morphine 0.1mg/ml,in group ROP with 0.2% ropivacaine combined with morphine 0.1mg/h,and in group BUP with 0.15% bupivacaine combined with morphine 0.1mg/ml. The VAS score, patients' overall impression of treatment, modified Bromage motor scale score, and severity of side effects after operation were recorded. Results: There was no significant difference in VAS score at 4h, 8h, 16h, 24h, 48h, and patients' overall impression of treatment at 48h, and modified Bromage motor scale score at 4h, and severity of side effects after operation (P>0.05). But there were two persons in group LBUP and group BUP respective whose modified Bromage motor scale score was two at 8h and recovered at 16h after operation. On the first postoperative day, the ropivacaine group had a higher percent of patients who were ambulatory for a little time than the levobupivacaine group and bupivacaine group (70% vs 40% and 36.7%; χ~2=5.45, χ~2=4.34,P<0.05). Conclusion: Postoperative epidural infusion with 0.15% levobupivacaine, 0.2% ropivacaine or 0.15% bupivacaine can provide effective analgesia. Postoperative recovery in 0.2% ropivacaine group was earlier than that in 0.15% levobupivacaine group and 0.15% bupivacaine group.