地佐辛复合罗哌卡因用于全子宫切除术后自控硬膜外镇痛的研究

Postoperative patient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hys-terectomy

目的观察地佐辛复合罗哌卡因用于全子宫切除术后白控硬膜外镇痛（PCEA）的有效性和安全性。方法选择择期妇科全子宫切除手术患者60例，随机均分为地佐辛复合罗哌卡因组（DR）和吗啡复合罗哌卡因组（MR）两组，两组镇痛药配置为：DR组0．225％盐酸罗哌卡因＋0．005％地佐辛（100m1）；MR组0．225％盐酸罗哌卡因＋0．003％吗啡3mg（100m1）。术毕给予负荷量5ml镇痛泵复合液，开启PCA，背景剂量为2ml／h，PCA为0．5ml／次，锁定时间为15min。分别记录两组术后1h、4h、8h、12h、24h、36h、48h的视觉模拟评分法（VAS法）、舒适度评分（BCS）、Ramsay镇静评分、PCEA有效按压次数及不良反应的发生情况。结果两组术后各时间点VAS评分、BCS评分、Ramsay镇静评分、PCEA的有效按压次数组间比较均差异无统计学意义（均P〉0．05），DR组患者恶心、呕吐、瘙痒的发生率较MR组均显著降低（均P〈0．05）。结论地佐辛复合罗哌卡因用于全子宫切除术后自控硬膜外镇痛，安全有效，不良反应发生率低。

Objective To observe the effect and safety of postoperative patient-controlled epidural analgesiawith dezocine plus ropivacaine in patients underwent hysterectomy. Methods 60 patients, ASA I - II, undergoing hysterectomy operation, were randomly divided into two groups. 0. 225% ropivaeaine with 0. 005% dezocine （ DR group） or 0.225% ropivacaine with 0.003 % morphine （ MR group） were given epidurally after surgery, respectively, with an initial loading dose 5ml, basal dose of 2ml/h, PCA dose of 0.5ml and lockout time of 15 min. Visual analogue score （ VAS）, Bruggemann comfort scale （ BCS ）, Ramsay sedation score （ RSS ）, PCEA effective compression of the times and adverse effects were determined and compared at lh,4h,8h, 12h,24h 36h and 48h after operation. PCEA effective compression of the number and incidence of adverse reactions were observed. Results There were no significant differences in VAS, BCS, RSS and PCEA effective compression of the times between two groups（ all P 〉 0. 05 ）. The percentage of nausea, vomiting and pruritus were significantly lower in group DR than that in group MR（ all P 〈 0. 05）. Conclusion Patient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hysterectomy had analgesic effect and safety,with less adverse effects.