布比卡因配伍芬太尼或吗啡用于术后硬膜外病人自控镇痛效应的比较

Comparison of bupivacaine-fentanyl with bupivacaine-morphine for postoperative patient-controlled epidural analgesia

目的采用硬膜外麻醉病人自控镇痛技术，对两种配伍布比卡因术后镇痛的临床效应进行比较。方法60例（ASAI～Ⅱ级）手术病例随机分为Bu－F组和Bu－M组。在术后患者感到疼痛时自行给药镇痛，给药剂量每次4～6ml，锁定时间为60分钟，每次PCA注射速度为5分钟，术后4、8、12、24小时随访并记录观察时间内用药量，疼痛评分（VAPS），平均动脉压，呼吸频率及恶心呕吐、搔痒等副作用。结果首24h各观察时间内Bu-F组用药量比Bu－F组多（P＜0．05），两组病人术后PCEA期IulCAS评分，无明显异常。两组观察期间动脉压，呼吸频率无明显变化．Bu-M组恶心呕吐发生率明显高于BI-F（P＜0．05）。结论布比卡因配伍芬太尼和布比卡因配伍吗啡用于PCEA时，镇痛效果均显著，但布比卡因配伍吗啡的副作用发生率较高，选择布比卡因配伍芬太尼较为适宜。

Objective To compare the effect of bupivacaine combining other two drugs for postoperative patient-controlled epidural analgesia(PCEA). Methods 60 Patients (ASA status Ⅰ or Ⅱ) undergoing with epidural anesthesia were randomly divided in two groups. Group Bu-F (n = 30): 0.2 % bupivacaine 300mg and 0.0002 % fentanyl 0. 3mg, group Bu - M (n = 30): 0. 2%, hupivacaine 300mg and 0. 005 % morphine 7. 5mg,both diluted to 150ml. The drugs were injected in epidural space postoperatively by patients own.The lockout time was 60mins, PCA dose was 4 - 6ml. and spent 5 mins each time, patients were followed up at 4, 8, 12, 24h after operation, and dose. vasual analog pain scale(VAPS) 、mean blood pressure、respiratory rates、adverse effects as prurititus 、nausea and vomiting were recorded. Results The dose of group Bu - F was larger than Bu - M in the first operative 24h (P < 0. 05 - 0. 01 ). There were no significant difference between the two groups in the VAPS,the portoperative mean blood pressure and respiratory rates were within thenormal ranges. The incidence of nausea and vomiting were higher in Bu - M group tha Bu - F (P< 0.05), and incidence of pruritus was higher in Bu - M group either (P >0. 05). Conclusion Bupivacaine combined with fentanyl or morphine were effective methods for PCEA avoiding postoperative Pain, and bupivacaine - fentanyl group had less adverse effects.