罗哌卡因伍用不同阿片类药物在硬膜外术后镇痛中的效果观察

Clinical Investigation of Postoperative Patient-controlled Epidural Analgesia with Ropivacaine Combined with Opioid

目的：对比观察罗派卡因分别伍用芬太尼和吗啡对上腹部手术后病人硬膜外自控镇痛（PCEA）的效果。 方法：41例择期上腹部手术。随机分为RM组和RF组，接受PCEA治疗。RM组为0．2％的罗派卡因加吗啡50μg／ml，RF组为0．2％罗派卡因加芬太尼5μg/ml．每次启动PCA泵给药6ml。 结果：RM组和RF组均可提供满意的术后镇痛．安静时RM组的VAS评分波动于27～38mm之间，RF组为28-39mm，活动时RM组的VAS为38～56mm之间。RF组兔36-58mm之间．两组间无显著性差异（P〉0.05），但RF组罗哌卡因的用量显著大于RM组（P〈0．01），RF组与RM组出现单侧或双下肢麻木的比例为5：1，恶心，呕吐、瘙痒．镇静评分及术后排气时间均无统计学差异（P〉0．05）。两组无一例呼吸抑制出现。 结论：0．2％的罗哌卡因加小剂量吗啡或芬太尼对上腹都手术后PCEA的效果相当，RM组可明显减少罗哌卡因的用药量。

Objective： To investigate the efficacy of postoperative patient-controlled epidural analgesia with ropivacaine combined with morphine or fentanyl. Methods： Forty-one ASA Ⅰ-Ⅱ patients undergoing elective major upper abdominal surgery were randomly divided into two groups： group RM （n=20） received postoperative PCEA with 0.2%ropivacaine plus 50pg/ml morphine, group RF received PCEA with 0.2% repivacaine plus 5pg/ml fentanyl. The bolus dose of PCEA was 6ml, and lock-out time 15min. Blood pressure, heart rate, respiratory rate, and SpO2 were monitored, Assessment of pain （VAS）, nausea-vomiting, motor block, pruritus and sedation were recorded during 48 h. Results： No difference in pain, nausea-vomiting, pruritus and sedation between groups. The 48h postoperative opioid consumption was morphine 3.80±1.63 mg and 575.10±180.86 pg fentanyl. Total consumption of 0.2%repivacaine was 78.00±23.14 ml in group RM and 121.05±32.77 ml in group RF. five patients in group RF complained of numbness in lower limbs while one patient in group RM. Conclusion： Both methods were effective in the prevetion of pain with an absence of serious side effects. However, the consumption of ropivacaine in group RF was larger than in group RM,