胸科术后罗哌卡因、布比卡因硬膜外镇痛效果比较及对呼吸功能的影响

Analgesia effect of ropivacaine and bupivacine by patient controlled epidural analgesia on post-thoracotomy pain and the influence on respiratory function

目的:探讨胸科全麻复合硬膜外麻醉术后罗哌卡因和布比卡因硬膜外镇痛的效果,并了解2者对患者呼吸功能的影响。方法:选取20例ASAI～II级,在全麻复合硬膜外麻醉下行择期胸科(食管、肺叶或纵隔手术等)手术的患者,随机分为2组,罗哌卡因组(n=10):术后接镇痛泵硬膜外应用1.25g/L罗哌卡因(含芬太尼2mg/L)镇痛;布比卡因组(n=10):术后接镇痛泵硬膜外应用1.25g/L布比卡因(含芬太尼2mg/L)镇痛。分别观察2组的镇痛效果、呼吸功能变化、坐立位时的呼吸频率、术后动脉血气、循环功能和副作用。结果:①术后1d、2d、5d静息时疼痛评分罗哌卡因组均明显低于布比卡因组(P均<0.05);术后1d、2d、5d咳嗽时疼痛评分罗哌卡因组均明显低于布比卡因组(P均<0.05)。②术后1d、2d二氧化碳分压罗哌卡因组均明显低于布比卡因组(分别为P<0.01和P<0.05),2组间动脉血氧分压差异无统计学意义。术后1d、2d、5d用力肺活量和呼气峰流速2组间差异无统计学意义。③术后副作用发生率组间差异无统计学意义。结论:1.25g/L罗哌卡因可安全用于开胸手术后硬膜外镇痛,镇痛效果明显优于1.25g/L布比卡因,并使术后患者维持更好的呼吸功能,且不增加副作用的发生率。

Aim ： To compare the analgesia effects of ropivacaine and bupivacine by patient controlled epidural analgesia（PCEA） on post-thoracotomy pain and observe the influence on respiratory function. Methods： Twenty adult patients, ASA grade Ⅰ～Ⅱ, undergoing selective thoractomy were randomly divided into two groups. Ropivacaine in 1.25 g/L ropivacaine group （group R, n = 10） and bupivacine in 1.25 g/L bupivacine group （group B, n = 10） were administered by PCEA. Results：The visual analogue scale （VAS） pain scores when patients were at rest were significantly lower in group R than that in group B on the 1 st, 2nd and 5th postoperative day（ P 〈 0.05 ）;the VAS scores when patients coughed were significantly lower in group R than that in group B （ P 〈 0.05 ） at all time-points. PCO2 was significantly lower in group R than that in group B on the 1 st and 2nd postoperative day（P 〈 0.05 or 0.01 ） ;there were no significant differences between the two groups regarding the forced vital capacity or peak expiratory flow rate at all time-points. Conclusion： Epidural administration of 1.25 g/L ropivacaine can be applied safely and effectively for post-thoracotomy analgesia. It is superior to 1.25 g/L bupivacaine and is better in maintaining respiratory function after thoracotomy.