经耻骨上前列腺切除术后罗哌卡因混合舒芬太尼病人自控硬膜外镇痛的效果

Efficacy of ropivacaine combined with sufentanil for patient - controlled epidural analgesia after prostatectomy

目的观察不同浓度罗哌卡因混合舒芬太尼病人自控硬膜外镇痛（PCEA）用于经耻骨上前列腺切除术（SPP）后的效果。方法SPP病人60例，ASAⅠ或Ⅲ级，随机分为3组：0．12％罗哌卡因混合舒芬太尼PCEA组（RL组）、0．2％罗哌卡因混合舒芬太尼PCEA组（RH组）和舒芬太尼病人自控静脉镇痛（PCIA）组（S组），每组20例。记录术后第6、24、48、72h（T6、T24、T48和T72）运动神经阻滞程度评分（Bromage评分）；记录术后即刻～6h、术后6～24h、术后24～48h和术后48～72h时段膀胱痉挛次数；采用视觉模拟评分法（VAS）记录病人膀胱痉挛时和非痉挛时疼痛程度；记录有关的副作用及术后72h膀胱冲洗液内红细胞的总数。结果①T6时Bromage评分RL组和RH组高于S组（P〈0．05或0．01），T24-72时RH组高于RL组和S组（P〈0．01），RL组与S组之间差异无统计学意义。②膀胱痉挛次数在术后6h内三组差异无统计学意义，术后6～72h，RL组和RH组低于S组（P〈0．05），其中术后6～24hRH组少于RL组（P〈0.05），术后24～72h，RH组和RL组之间差异无统计学意义。③在膀胱痉挛时，VAS评分RH组和RL组低于S组（P〈0．05），RH组和RL组差异无统计意义。在非膀胱痉挛时，三组之间差异无统计学意义。④RL组和RH组术后72h膀胱冲洗液内红细胞总数低于S组（P〈0．01），RL组与RH组差异无统计学意义。结论与舒芬太尼PCIA相比，SPP后使用0．12％或0．2％的罗哌卡因混合舒芬太尼进行PCEA，能更有效地减少膀胱痉挛，减少前列腺窝创面的出血量。SPP后不同时段采用不同浓度的罗哌卡因混合舒芬太尼进行PCEA，效果更好。舒芬太尼镇痛效果好，安全性高。

Objective To investigate the efficacy of patient- controlled epidural analgesia （PCEA） with ropivacaine plus sufentanil for postoperative analgesia after prostatectomy. Methods Sixty ASA H or m patients aged 62 -78 years weighing 52 -84 kg undergoing prostatectomy were randomly divided into 3 groups with 20 patients in each group： group Ⅰ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml. group Ⅱ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml and group m received patient - controlled intravenous analgesia （PCIA） with sufentanil 1 μg/ml. Postoperative pain was assessed using VAS （0 = no pain, 10 = worst pain）. The degree of motor blockade （ modified bromage scale） was evaluated at 6, 24, 48 and 72 h after operation（T1-4）. Bladder spasm episodes were recorded. Side effects including nausea, vomiting and pruritus and the total number of RBC in rinse solution were also recorded. Results ①Bromage score（0 = no motor block,3 = inability to flex ankle joint）was significantly higher in group Ⅰ and Ⅱ than in group Ⅲ at T1 （6 h after op. ） ,but ingnificantly lower in group Ⅰ and Ⅲ than in group Ⅱ at T2-4 （24 -72 h after operation）. ②VAS score（0 = no pain, 10 =worst pain）was not significantly different among the 3 groups without bladder spasm but significantly higher in group m than in other 2 groups during episodes of bladder spasm. ③The number of bladder spasm episodes was not significantly different among the 3 groups with in 6h after operation, but was significant larger in group Ⅲ than in the other two groups during 6 - 72 h after operation. During 6 -24 h after operation more bladder spasm attacks occurred in group Ⅰ than in group Ⅱ. ④The incidence of side effects was significantly lower and the total number of RBC in rinse solution was significantly smaller in group Ⅰ and Ⅱ than in group Ⅲ. Conclusion PCEA with 0.12% or 0.2% ropivacaine plus sufentanil can effectively reduce the number of bladder spasm attack and postoperative bladder bleeding. Different concentrations of ropivacaine should be used for PCEA during different postoperative periods.