左旋布比卡因与布比卡因用于老年患者股骨头置换术后镇痛的比较

Comparison of postoperative analgesia with continuous epidural infusion of fentanyl combined levobupivacaine or bupivacaine in elderly patients undergoing femoral head replacement

目的比较硬膜外腔芬太尼复合0.15%左旋布比卡因或0.15%布比卡因用于老年患者股骨头置换术后镇痛的效果及对呼吸循环的影响。方法 70例ASAⅡ-Ⅲ级,年龄70-88岁,择期在腰硬联合麻醉下行股骨头置换术患者,随机分为0.15%左旋布比卡因组和0.15%布比卡因组。于手术结束后经硬膜外导管2ml/h分别持续注入0.15%左旋布比卡因或0.15%布比卡因,均复合3μg/ml芬太尼和托烷司琼0.06mg/ml,测定术后4,8,12,24,48h视觉模拟评分(VAS),镇静评分(Ramsay),记录平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)及不良反应。结果两组患者的镇痛效果相当,MAP、HR、SpO2等生理指标差异无统计学意义,均无呼吸抑制发生,恶心呕吐、尿潴留等副反应的发生率在两组相似。结论硬膜外腔芬太尼复合0.15%左旋布比卡因或0.15%布比卡因用于老年患者股骨头置换术后镇痛效果及对呼吸循环的影响相似。

Objective To compare the efficiency of continuous epidural postoperative analgesia with 0.15% levobupivacaine and 3 μg/ml fentanyl or 0.15% bupivacaine and 3 μg/ml fentanyl,and to explore their effects on respiration and circulation of elderly patients undergoing femoral head replacement. Methods Seventy patients （ASA Ⅱ-Ⅲ,aged 70-88 years） scheduled for femoral head replacement in combined spinal-epidural block were randomly divided into 2 groups （35 in each group）：levobupivacaine group and bupivacaine group.After the operation,0.15% levobupivacaine with 3 μg/ml fentanyl and 0.06 mg/ml tropisetron or 0.15% bupivacaine with 3μg/ml fentaynl and 0.06 mg/ml tropisetron was continuously infused into the epidural space in levobupivacaine group and bupivacaine group,respectively.Visual analogue score （VAS）,Ramsay scale,mean arterial pressure（MAP）,heart rate （HR）,pulse oxygen saturation （SpO2） and adverse reaction were determined and compared at 4 h,8 h,12 h,24 h and 48 h after operation. Results There was no significant difference in VAS,Ramsay scale,MAP,HR and SpO2 between two groups（P〈0.05）.No respiratory depression was found in all patients.The incidence rate of nausea and vomiting and urinary retention showed no difference between two groups （P〈0.05）. Conclusion Continuous epidural postoperative analgesia of 0.15% levobupivacaine or 0.15% bupivacaine combined with 3 μg/ml fentanyl and 0.06 mg/ml tropisetron have the similar analgesia and respiration-circulation effects in elderly patients undergoing femoral head replacement.