罗哌卡因复合舒芬太尼用于肺癌患者术后镇痛的临床观察

Post-operative Epidurai Analgesia with Ropivacaine Combined Sufentanil Patients Undergone Lung Cancer Surgery

目的评估罗哌卡因复合不同浓度舒芬太尼用于肺癌手术后硬膜外镇痛（PCEA）效果及不良反应。方法选取择期肺癌行肺叶切除术患者90例,年龄20~67岁,随机分成3组,每组30例,术前T6-7行硬膜外穿刺,留置导管,术后接硬膜外镇痛泵。分别用罗哌卡因复合舒芬太尼0.1μg/ml（Ⅰ组）、0.2μg/ml（Ⅱ组）和0.3μg/ml（Ⅲ组）,观察术后2、4、8、12、14、36、48 h的安静和咳嗽时疼痛VAS评分,不良反应和追加使用吗啡和PCEA按压情况。结果术后2、4、8 h,Ⅱ、Ⅲ组安静和咳嗽时VAS评分均明显低于Ⅰ组（P〈0.05）;术后16、24 h,Ⅱ组、Ⅲ组咳嗽时VAS评分仍低于Ⅰ组（P〈0.05）。Ⅱ组、Ⅲ组PCEA按压次数显著少于Ⅰ组（P〈0.01）,追加吗啡量也明显低于Ⅰ组（P〈0.01）。结论 0.15%罗哌卡因合用0.1、0.2、0.3μg/ml舒芬太尼针用于PCEA均可获得满意的镇痛效果,但推荐0.15%罗哌卡因合用0.2/ml为首选,镇痛效果好,不良反应低。

ObjectiveTo evaluate the clinical outcomes of postoperative epidural analgesia with Ropivacaine combined with sufentanil in patients undergone lung cancer surgery.MethodsNinety patients aged from 20 to 66 years old undergone lung cancer were randomized into three groups,with 30 cases each group.Patientcontrolled epidural analgesia（PCEA）was used with Ropivacaine 0.15% plus sufentanil 0.1 μg/ml in group Ⅰ,plus sufentanil 0.2 μg/ml in group Ⅱ,or plus sufentanil 0.3 μg/ml in group Ⅲ,Visual analog scale（VAS）pain scores at calm condition and during coughing were evaluated and side effects were recorded during analgesia.ResultsIn 2,4,8h after operation,VASscores at calm ciydution and during coughing of group Ⅱ and Ⅲwere less than that of guoup Ⅰ（P0.05）.ConclusionPCEA with 0.15% Ropivacaine combined 0.1,0.2 or 0.3 μg/ml provides a satisfactory analgesic efficacy in patients undergone lung cancer surgery.Ropivacaine 0.15% combined with Sufentanyl 0.2 μg/ml is preferable recommendation with lower incidence of adverse events.