罗比卡因、左布比卡因、布比卡因对食管贲门癌术后镇痛的临床观察

Clinical observation of post operation use ropivacianc,L-bupivacaine and bnpivacaine as painkiller in senile patients with esophageal cardial carcinoma

目的观察相同浓度罗比卡因、左布比卡因、布比卡因伍用吗啡、氟哌利多用于食管贲门癌术后胸段硬膜外自控镇痛(PCEA)的有效性及安全性。方法选择60例择期食管贲门癌开胸手术老年患者,随机分为0．1％罗比卡因组(Ⅰ组)、0．1％左布比卡因组(Ⅱ组)、0.1 %布比卡因组(Ⅲ组),每组20例,局麻药等量,均复合等量吗啡、氟哌利多,速率均为4 ml／h。观察三组患者术后的疼痛评分(VAS)、PCA按压次数与有效次数及不良反应。结果术后4、16、32、48 h VAS评分三组差异无统计学意义(P>0．05);PCA按压次数及有效次数、恶心呕吐、皮肤瘙痒等差异无统计学意义(P>0．05);血压下降Ⅰ、Ⅱ组与Ⅲ组比较差异有统计学意义(P<0．05)。结论0．1％罗比卡因、0,1％左布比卡因、0．1％布比卡因伍用吗啡、氟哌利多用于食管贲门癌开胸术后老年患者PCEA镇痛效果一样,0,1％罗比卡因对循环影响小。

Objective To study the effectiveness and safety about using the same concentration ropivaciane, L-bupivacaine and bupivacaine combined with morphine narfloridoe in esophageal cardiac carcinoma in senile patients as postoperative thoracic-extradural self comrol painkiller. Methods 60 cases of esophageal cardiac carcinoma patients under thoracotomy operation in senile patients were randomly divided into 0.1% ropivaciane group （group Ⅰ ） ,0.1% L-bupivacaine group（group Ⅱ ） and 0.1% bupivacaine group（group Ⅲ ） ,each group included 20 cases. The local anaesthesia drug volume were the same and combine with same volume morphine, norfloridoe,speed rate all 4ml/h,pain evaluation（VAS） in these three groups were observed and gave scores,PCA pressure dines and effective times and side effects were recorded. Results Postoperative 4.16,32,48h VAS evaluation were no difference in three groups（ P 〉 0.05 ）, PCA pressure times and effective times, nausea and vomiting pruritis all no conspicuous difference（P 〉0.05）,but decrease of BP in group Ⅰand Ⅱ had conspicuous difference compared with group Ⅲ （P〈 0.05）. Conclusion 0.1% ropivaciane,0.1% L-bupivaeaine,0.1% bupivacaine,combine with morphine narfloridol use in esophageal cardiac carcinoma thoracotomy in senile patients as postoperative painkiller（PCEA）,the effects are true,0.1% ropivaciane use in senile patients post thoraeotomy as painkiller has little influence to circulation and high safety.