左旋布比卡因用于良性前列腺增生摘除术后患者自控硬膜外镇痛效果及循环应激反应的影响

Effect of PCEA with L-bupivacaine after Benign Prostatectomy and its Influence on Stress Response of Circulation

目的：研究左旋布比卡因伍用芬太尼在良性前列腺增生摘除术后患者自控硬膜外镇痛效果及循环应激反应的影响。方法：随机选择ASAⅠ-Ⅱ级，年龄55～75岁、择期作良性前列腺增生耻骨上经膀胱前列腺摘除术40例为患者自控硬膜外镇痛组（PCEA组），另随机选择同类手术患者40例为哌替啶肌注镇痛组（PMA组）。在PCEA组镇痛药液为芬太尼0．5mg、氟哌利多5mg和左旋布比卡因187．5mg用生理盐水配至100ml。PMA组当患者疼痛难忍时，每次肌注哌替啶0．8mg／kg。分别采用视觉模拟评分（VAS）评定镇痛效果，监测并记录麻醉前、术毕、术后6、12、24h的BP、HR值，并计算心率收缩压之积（RPP），同时采肘静脉血，用高效相色谱法测定血浆去甲肾上腺素（NE）和肾上腺素（E）的浓度，术后膀胱冲洗量、出血量膀胱痉挛两组患者例数，镇痛期间的不良反应。结果：术后各时点的VAS评分PCEA组较PMA组显著低（p〈0、05或p〈0．01）PMA组术后各时点的HR、SBP、RPP、CA及术后6、12h的DBP均较麻醉前明显增高（P〈0．05P或〈0．01），PCEA组除NE于术后6h。较麻醉前高外（P〈0．01），其余指标与其麻醉前相比元显著差异（P〉0．05），术后各时点的RPP、血浆CA及术后6、12h的SBP、DBP、HR值均明显低于PMA组（P〈0．05或P〈0．01）。术后膀胱冲洗量、出血量、膀胱痉挛例数PMA组均高于PCEA组（P〈0．05）。结论：左旋布比卡因伍用芬太尼在良性前列腺增生摘除术后患者自控硬膜外镇痛效果理想对循环应激反应的影响较小。

Objective：To study the effect of postoperative patient-controlled epidural analgesia with L-bupivacaine and fentanyl after benign prostatectomy and its influence on the stress response of circulation. Methods：Forty cases ASA Ⅰ-Ⅱ undergone elective prostatectomy, aged from 55 to 75, were randomly enrolled into the patient-controlled epidural analgesia group （ PCEA ）. Forty other cases suffered the similar symptoms were randomly enrolled into the pethidine intramuscular injection group （PMA）. In the PCEA group, 100ml Sodium Chloride contains fentanyl 0.5mg, droperidol 5mg and L-bupivacaine187.5mg. In the PMA group, pethidine 0.8mg/kg was injected each time when the patient can＇ t bear. The effect Was evaluated by visual analogue pain scales. Blood pressure （ BP ） and heart rate （ HR ） was monitored and recorded before aneshtesia,at completion of operation and 6 hours, 12 hours, 24 hours postoperatively. The result of HR multiplied by systolic BP was also recorded. At the same time blood sample was taken through ulnar vein. The concentration of plasma NE and E was detected by high performance liquid chromatography. Flushing dose of bladder, hemorrhage volume, the number of patients suffered bladder spasm and adverse reaction postoperatively were recorded in detail. Results：VAS of the PCEA group was significantly lower than that of the PMA group （P 〈0.05 or P 〈0.01 ） at each period postoperatively. In the PMA group HR,SBP,RPP, CA at every period and DBP at 6 hours, 12 hours postoperatively was significantly higher（ P 〈0.05 or P 〈0. 01 ） than that of before aneshtesia. Compared with the parameter before aneshtesia , there is no significant different in the PCEA group. Only the NE is significant higher than that of before aneshtesia in the PCEA group. In the PCEA group RPP,eplasma CA at every period and SBP,DBP , HR at 6 hours, 12 hours postoperatively was significantly lowerer than that of the PMA group （ P 〈 0.05 or p 〈 0.01 ）. Flushing dose of bladder, hemorrhage volume, the number of patients suffered bladder spasm in the PMA group was significant higher than that of the PCEA group （ p 〈 0.05 ）. Conclusion： Patient-controlled epidural analgesia with L-bupivacaine and fentanyl postoperatively after benign prostatectomy is highly effective and has little influence on stress response of circulation.