盐酸丁丙诺啡复合布比卡因用于老年患者术后硬膜外自控镇痛的疗效观察

Observation on Effect of Postoperative Patient-controlled Epidural Analgesia with Buprenorphine and Bupivacaine in Elderly Patients

【目的】观察丁丙诺啡复合布比卡因用于老年患者术后硬膜外自控镇痛（PCEA）的疗效及不良反应。【方法】70～85岁膀胱癌或前列腺增生患者60例，随机分为A、B、C三组，术毕均采用硬膜外自控镇痛，其中A组配方为吗啡5mg＋0．75％布比卡因15mL＋0．9％氯化钠溶液稀释至100mL，B组、C组分别将吗啡改为丁丙诺啡0．45mg或0．3mg。观察术毕（t1）、术后3h（t2）、6h（t3）、12h（t4）、24h（t5）、拔除PCA时（t6）的心率（HR），平均动脉压（MAP），血氧饱和度（Sp02）；视觉模拟评分（VAS），Ramsay镇静评分（RSS）；t1～t6PCA按压次数及总用量；不良反应。【结果】三组HR、MAP、Sp02及VAS无明显差别；A组患者RSS在t3、t4高于术毕，且从t3～t6B、C两组明显低于A组，C组明显低于术毕（P＜0．01）；PCA按压次数C组明显多于B和A组（P＜0．01），总用药量C组＞B组＞A组（P＜0．01）；A组有较多的恶心呕吐病例（P＜0．01），有4例患者出现嗜睡现象（P＜0．05），但无明显呼吸抑制。【结论】丁丙诺啡复合布比卡因能安全有效用于老年患者术后PCEA，其中以丁丙诺啡0．45mg配方较为适宜。

[Objective]To observe the effect of patient-controlled epidural analgesia（PCEA） with buprenorphine and bupivacaine in elderly patients and its adverse reaction. [Methods] Sixty cases with bladder cancer or prostatic hyperplasia （aged 70～85 years old） were randomly and equally divided into three groups （i. e. group A,B,C）. All of them took PCEA at the end of operation. Morphine 5mg＋0.75% bupivacaine 15mL＋0.9%NS was diluted 100 ml in group A, and morphine was changed into buprenorphine 0.45mg or 0. 3mg in group B or group C respectively. The heart rate （HR）, mean arterial pressure （MAP）, saturation of blood oxygen （SpO2）, visual stimulation score （VAS）, Ramsay sedation score （RSS） in three groups were observed at the end of operation（t1 ）, and 3h（t2 ）, 6h（t3 ）, 12h（t4 ）, 24h（t5 ） after operation. The frequency of t1～t6 PCA pressing, PCA dosage and side reaetions were also observed. [Results] There were no statistically significant difference in HR, MAP, SpO2 and VAS. the RSS at t3 ,t4 of group A were apparently higher than that of the end of operation, from t3 ～t6, the RSS of group B,C were apparently lower than group A, and the RSS of group C were apparently lower than that of the end of operation（ P 〈0.01）. PCA bolus times of group C were apparently higher than that of group B or group A（ P 〈0. 01）, There were statistically significant difference about PCA dosage of three groups（C〉B〉A , P 〈0.01） ; there are more cases of nausea and vomi- ting in group A（ P 〈0.01） ,4 cases of group A were sleepiness（ P 〈0.05） ,but there were not respiration depression. [Conelusion]Buprenorphine eonbined bupivaeaine can safely and effectively analgesia on aged by PCEA ,and the better dosage of buprenorphine is 0.45mg.