咪达唑仑复合罗哌卡因硬膜外自控镇痛的效应

The efficacy of midazolam combined with ropivacaine on patient controlled epidural analgesia

目的:评价咪达唑仑复合罗哌卡因术后硬膜外自控镇痛的临床效果。方法:选择下肢骨科手术患者50例,随机分成Ⅰ组25例和Ⅱ组25例。两组患者均行L2、3或L3、4腰硬联合穿刺术并头向置管4cm。术后行硬膜外自控镇痛(PCEA)。Ⅰ组PCEA配方为咪达唑仑5mg加0.2%罗哌卡因100ml,首剂咪达唑仑2mg加罗哌卡因8mg;Ⅱ组PCEA配方为吗啡5mg加0.2%罗哌卡因100ml,首剂吗啡2mg加罗哌卡因8mg。两组均行持续输注量2ml/h,单次PCA量1ml,锁定时间15分钟。结果:镇痛满意率(VAS≤3)Ⅰ组为92%与Ⅱ组96%相近(P>0.05);Ⅰ组尿潴留12%、恶心呕吐4%,均低于Ⅱ组(P<0.05或P<0.01)。结论:咪达唑仑复合罗哌卡因术后PCEA镇痛效果满意,不良反应少,是较好的镇痛方法。

Objective：To evaluate the effect of midazolam combined with mpivacaine on patient controlled epidural analgesia （PCEA）.Methods：Fifty patients undergoing orthopedic operation in lower limb were randomly divided into group Ⅰ （n=25）and group Ⅱ （n=25）.The puncture of combined spinal-epidural anesthesia in both groups was performed at L2,3 or L3,4 and epidural catheter was placed at L2,3 or L3,4. PCEA was performed at postoperation.The solution of PCEA in group Ⅰ was 0.2% ropivacaine 100 ml plus midazolam 5 mg and the first dose was midazolam 2 mg plus mpivacaine 8 mg;That in group H was 0.2% ropivacaine 100 ml plus mot phine 5 mg and the first dose was morphine 2 mg plus ropivacaine 8 mg.Background infusion in both groups was 2 ml/h, PCA bolus 1 ml demand,lockout interval 15 min.Results：Tbe satisfactory rate of postoperative analyesia in the group Ⅰ was 92% and similar to 96% in group Ⅱ （P〉0.05）oln group Ⅰ the urinary retention was 12% and nausea vomiting was 4%,both〈thos in group Ⅱ .Conclusion：Midazolam combined with ropivacaine on patient controlled epidural analgesia produces satisfactory postoperative analgesia with less complications, and is a better analgesia method.