地佐辛罗哌卡因用于术后硬膜外自控镇痛临床研究

Clinical research of Dezocine Ropivacaine for PCEA

目的:观察地佐辛复合罗哌卡因在术后硬膜外自控镇痛(PCEA)的临床效果和不良反应;方法:选择择期行全子宫切除术患者120例随机分为4组,每组30例;L组给予0.2%罗哌卡因;DL组给予地佐辛5 mg+0.2%罗哌卡因;FL组给予芬太尼5μg/kg+0.2%罗哌卡因;FLF组给予芬太尼5μg/kg+氟哌利多2.5 mg+0.2%罗哌卡因;镇痛药总量均为200 ml,给药模式均采用负荷剂量5 ml,背景流速5 ml/h,单次按压追加(PCA)剂量3 ml,锁定时间15 min。观察术后第1、4、8、12、24、48小时各时点的静息疼痛并进行视觉模拟疼痛(VAS)评分,记录PCEA期间各种不良反应。结果:L组术后4、8、12、24 h各时点VAS评分和PCEA平均有效按压次数与DL组、FL组和FLF组比较,差异有统计学意义(P<0.05),而DL组、FL组和FLF组差异无统计学意义(P>0.05),术后1 h和48 h时4组间VAS评分差异无统计学意义(P>0.05)。L组、DL组和FLF组在恶心、呕吐方面,差异无统计学意义(P>0.05),与FL组比较,差异有统计学意义(P<0.05),而FLF组有2例出现了锥体外系反应。结论:地佐辛复合罗哌卡因用于术后PCEA镇痛效果好,不良反应少。

Objective： To observe the clinical effect and adverse reactions of Dezocine Ropivacaine in patient controlled epidural analgesia （PCEA）. Methods： 120 cases of elective hysterectomy were randomly divided into 4 groups with 30 cases in each group; group L was given 0.2% Ropivacaine; Group DL with Dezocine 5 mg＋0.2% Ropivacaine; group FL with Fcntanyl 5 μg/kg＋0.2% Ropivacaine; group FLF with Fentanyl 5μg/kg＋ Dropefidol 2.5 mg＋0.2% Ropivacaine; total analgesics was 200 m], Premedieation mode loading dose was 5 ml, background flow was 5 ml/h, single press additional （PCA） dose was 3 ml, lockout time was 15 min. To observe resting pain and make VAS score in 1, 4, 8, 12, 24, 48 h after surgery and record a variety of adverse reactions during PCEA. Results： VAS scores of 4, 8, 12, 24 h after surgery and PCEA average effective compression frequency of group L were significantly different with Group DL, Group FL and group FLF （P〈 0.05）, but there was no significant difference between Group DL, Group FL and group FLF （P〉0.05）, VAS scores among the 4 groups in 1, 48 h after surgery had no significant difference （P〉0.05）. group L, group DL and the group FLF had no significant difference in nausea, vomiting （P〉0.05）, but there was significant difference compared with the group FL （P〈0.05）, and 2 patients of group FLF had extrapyramidal reactions. Conclusion： The analgesic effect of Dezocine Ropivacaine for postoperative PCEA is good and adverse reaction is less