罗哌卡因联合吗啡或芬太尼镇痛效果及对肠蠕动的影响临床分析

Clinical investgation of ropivacaine combined morphine or fentanyl for patient controlled epidural analgesia on intestinal peristalsis

目的：探讨罗哌卡因联合不同镇痛药物对手术后肠蠕动恢复情况的影响。方法：对105例普外科择期手术患者，ASAⅠ-Ⅱ级，根据不同的镇痛方案随机等分成3组。吗啡组：0．125％罗哌卡因＋0．005％吗啡＋0．005％氟哌利多：芬太尼组：0．125％罗哌卡因＋0．0005％芬太尼＋0．005％氟哌利多；对照组：为不实施术后自控镇痛患者；镇痛治疗后4、8、12、24、36h进行随访，观察疼痛程度、镇静状态、平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏氧饱和度（Sp02），并记录肠蠕动恢复时间。结果：吗啡组与芬太尼组均取得较好的镇痛效果，VAS评分显著低于对照组（P〈0．01）；芬太尼组较吗啡组、对照组肠蠕动恢复时间明显缩短（P〈0．05）。结论：罗哌卡因联合吗啡、芬太尼行患者术后自控镇痛均能获得良好的效果，罗哌卡因与芬太尼联用可缩短肠蠕动的恢复时间。

Objective：To investigate the effects of patient controlled epidural analgesic （PCEA） used ropivacaine and diferent analgesic drugs on recovery of postoperative intestinal peristalsis. Methods： 105 patients of abdominal surgery undergoing selection operating, ASA Ⅰ,Ⅱ grade.Every section was randomly divided into three groups according to the content of drugs.Morphine group：0.125% ropivaeaine＋0.005% morphine ＋0.005% droperidol.Fentanyl group ： 0.125% ropivaeaine ＋0.0005% fentanyl ＋0.005% droperidol.Control group was not given PCEA.All patients took PCEA for 36.The pain scores of visual analog scale（VAS）, sedative scores of Ramsay scale, respiratory and hemodynamie paremeters, and side effects were recorded at 4,8,12,24,36 h postoperatively.The time of the recovery of intestinal peristalsis was also recorded.Results：Good analgesic effect could be found in morphine group and fentanyl group,the VAS grades were significantly lower in morphine group and fentanyl group than that in control group （P〈001）.The time of the recovery of intestinal peristalsis was shorter in fentanyl group than that in morphine group and control group respectively （P〈0.05）. Conclusion：The compound solution with low concentration of ropivacaine and morphine or fentanyl can be used for postoperative analgesia,and ropivacaine com- bined with fentanyl can shorten the time of the recovery of intestinal peristalsis.