不同镇痛方法镇痛效果及对肠蠕动的影响

Effect of epidural analgesia with different methods on intestinal peristalsis

目的研究不同镇痛方法的镇痛效果及对肠蠕动的彤响。方法随机选择下腹部、下肢手术患者120例，随机分为四组，每组（n=30）下腹部、下肢手术各15例。A组（芬太尼组）：0．2％罗哌卡因＋0．0002％芬太尼＋0．005％氟哌利多；B组（吗啡组）：0．2％罗哌卡因＋0．01％吗啡＋0．005％氟哌利多；C组（局麻药组）：0．2％罗哌卡因；D组（对照组）：0．9％氯化钠注射液。均在硬膜外麻醉下手术，术后施行硬膜外腔镇痛。镇痛后48h内随访患者，记录疼痛程度及肠蠕动恢复时间。结果A、B两组均能提供良好的镇痛，其优良率分别为93％、97％，C、D组镇痛效果差，其优良率分别是47％、13％：A、B两组镇痛效果明显优于C、D组（P〈0．05）。下肢手术患者比下腹部手术患者肠蠕动恢复时间短（P〈0．01）；同类手术，四组患者间肠蠕动恢复时间差异无统计学意义（P〉0．05）。结论罗哌卡因联合芬太尼或吗啡术后镇痛都能取得满意的镇痛效果，下肢手术患者比下腹部手术患者肠蠕动恢复时间短。

Objective To explore the effect of PCEA on intestinal peristalsis. Methods 120 patients with ASA I - II lower abdominal or lower limbs surgery were randomly divided into four groups with 30 cases each and received PCEA at the end of operation sespectively. Group A were given 0. 0002% fentanyl,0.2% Ropivacaine and 0. 005% Droperidol;0.01% morphine,0.2% Ropivacaine and 0.005% dropefidol in group B;0.2% Ropivacaine in group C ;0.9% saline in group D. Postoperative analgesia was provided by PCA pump with LCP model. Results Sat- isfactory analgesia in group A was 93% ,97% in group B 47% in group C and 13% in group D. Both group A and B did not show any significant difference in the analgesic effects （p 〉 0, 05 ）. Satisfactory analgesia in group A and B were significantly better than in group C and D （ P 〈 0. 05 ）. The renewal of intestinal peristalsis were significantly faster in lower limbs surgery patients than lower abdominal patients（ P 〈0, 01 ） ,but it did not show any significant difference in the same kinds of surgery in four groups （ P 〉 0. 05 ）. Conclusion Both group A and B can get a satisfied analgesia effect;intestinal peristalsis of lower limbs surgery patients renewed were shorter than in lower abdominal patients.