不同浓度罗哌卡因在老年病人术后自控镇痛的应用研究

The practical study of different density of Ropivacaine injection in self-controllable analgesia after operation in elderly patients

目的探讨不同浓度的罗哌卡因在老年病术后自控镇痛的效果、安全性及合适的使用浓度。方法选择ASAI^II级的老年病人(年龄大于65岁),腹部择期手术216例,随机分为N、M、G三组,每组72例,所有病例术毕经镇痛泵注入该组镇痛液。N组:0.125%罗哌卡因+2μg/m l芬太尼;M组:0.16%罗哌卡因+3μg/m l芬太尼;G组:0.2%罗哌卡因+3μg/m l芬太尼。术后4、8、12、24、48 h进行镇痛、镇静评分,观察不良反应。结果术后4、8、12、24、48 h静息状态下N、M、G三组病人视觉模拟评分(VAS)评分无显著差异(P>0.05),但N组术后咳嗽、起床活动VAS评分较高,与M、G组相比,有显著差异(P<0.05),不良反应在G组中的发生率较高,但三组间无显著差异(P>0.05)。结论N、M、G三组不同浓度罗哌卡因术后镇痛对老年病人都安全、效果均较好。但以M组0.16%罗哌卡因复合芬太尼对老年病人术后镇痛更为合理。

Objective Studying the suitability, safety and effect of self - controllable analgesia using different density of Ropivacaine injection after operation in elderly patients. Methods According to the grade of ASAⅠ-Ⅱ （ elder than 65 ）, we collected 216 cases of choice operation and divided into three groups randomly, namely group N, M,G. After operation, all patients had been injected into the different density of drug of analgesia through the pump of analgesia according to the group, which group N contained 0. 125 % of Ropivaeaine and 2ug/ml of Fentanyl;group M cotained 0. 16% of Ropivacaine and 2 ug/ml of Fentanyl;grotlp G contained 0. 2% of Ropivaeaine and 3ug/ml of Fentanyl,then valuation the effect of analgesia and observation of the side - effect accorling to 4,8,12 and 48h after operation. Results in silence status,all groups had no obvious difference in value of VAS（ P 〈0.05 ） ,but in group N ,had higher of the value of VAS after cough and active and had more obvious difference than group M,G（ P 〈 0.05 ）. In side -effect, there were no obvious difference in three groups, but the group G had higher ratio. Conclusion Three groups of Ropivacaine had the effect and safety in analgesia to the elderly patient after operation,but group M had more suilable than others.