剖腹产术后低浓度罗哌卡因与布比卡因硬膜外自控镇痛效果对比观察

Observation on the effect of patient controlled epidural analgesia between low concentration ropivacaine and bupivacaine after abdominal delivery

【目的】探讨剖腹产术后应用低浓度罗哌卡因和布比卡因硬膜外自控镇痛效果、运动阻滞和副作用的异同。【方法】将80例足月行剖腹产手术的患者随机分为A组(0.2%罗哌卡因100 ml+吗啡3.0 mg+氟哌利多5.0 mg)和B组(0.2%布比卡因100 ml+吗啡3.0 mg+氟哌利多5.0 mg)。手术后分别进行硬膜外自控镇痛,观察术后4、12、24、48 h的生命体征,并记录镇痛效果、镇静评分、运动阻滞评分、不良反应及48 h总用药量。【结果】A组下肢运动阻滞改良Bromage评分在12、24及48 h分别显著低于B组评分(P<0.01),A组和B组镇静、镇痛评分及副作用发生率均无显著差异。【结论】低浓度罗哌卡因复合吗啡用于剖腹产术后硬膜外自控镇痛时下肢运动阻滞反应较弱,应用效果优于布比卡因。

[Objective] To investigate and compmare the effect of patient controlled epidural analgesia （PCEA）, the movement block and side reaction between low concentration ropivacaine and bupivacaine. [Methods] 80 cases of abdominal delivery were randomily divided into two groups. Cases of Group A were giving the following prescription： 100 ml of 0.2% ropivacaine ＋ 3.0 mg of morphine ＋ 5.0 mg Droperidol. Cases of Group B were giving the following prescription： 100 ml of 0.2% bupivacaine ＋ 3.0 mg of morphine ＋ 5.0 mg Droperidol. Such medicine were giving after operation, and the vital sign, effect of analgesia, score of calm, score of motion blockage, side reaction and total quantity of medicine were recorded. [Results] Scores of modified Bromage of group A were significantly lower than those of group B 12, 24 and 48 h after operation respectively （P 〈 0.01 ） . The effect of calm, the scores of analgesia and rate of side reaction between group A and group B was not significant. [Conclusions] Low concentration of ropivacaine combined with morphine has little movement block in the lower limbs when it was used after abdominal delivery, the application effect is better than that of low concentration bupivacaine.