喷他佐辛复合罗哌卡因用于子宫切除术后硬膜外镇痛的临床研究

Clinical Study of Patient-controlled Epidural Analgesia with Pentazocine Combined with Ropivacaine After Abdominal Hysterectomy

目的：研究不同剂量的喷他佐辛复合罗哌卡因用于腹式子宫全切术后硬膜外患者自控镇痛的效果与不良反应,探讨较适当的喷他佐辛镇痛剂量。方法：选择美国麻醉医师协会（ASA）麻醉分级Ⅰ~Ⅱ级,行腹式子宫全切手术患者120例,随机分为4组,每组30例。P1组：喷他佐辛90 mg;P2组：喷他佐辛150 mg;P3组：喷他佐辛180 mg;F组：芬太尼0.4 mg。各组均复合0.2%盐酸罗哌卡因加至100 mL硬膜外镇痛。比较4组术后不同时点的视觉模拟评分法（VAS评分）、Ramsay镇静评分、病人自控性镇痛（patient-controlled analgesia,PCA）泵的患者按压次数（D1）与实际进入次数（D2）以及不良反应的发生率。结果：P1组术后各时点的VAS评分均高于P2,P3及F组（P〈0.05）,P2及P3组术后各时点的VAS评分与F组差异无统计学意义（P〉0.05）;P2组术后4 h,8 h及12 h的Ramsay镇静评分均高于P1组（P〈0.05）,P3及F组术后各时点的Ramsay镇静评分均高于P1组（P〈0.05）,与P2组比较,P3及F组术后8 h、12 h及24 h的Ramsay镇静评分均升高（P〈0.05）;P1组术后8 h、12 h及24 h的D1/D2比值均高于P2、P3及F组（P〈0.05）;F组的恶心及呕吐发生率高于P2组和P3组（P〈0.05）。结论：腹式子宫全切术后150 mg的喷他佐辛复合0.2%罗哌卡因可达到有效的硬膜外镇痛效果,且不良反应发生率较低,是一种较为安全有效的硬膜外术后镇痛方法。

Objective： To observe the analgesia and side-effects of patient-controled epidural analgesia（PCEA） with different doses of pentazocine combined with ropivacaine after abdominal hysterectomy,so as to find appropriate analgesic dose of pentazocine.Methods： 120 patients selected ASA Ⅰ~Ⅱ having abdominal hysterectomy were randomly divided into 4 groups.Each group included 30 patients.P1 Group：pentazocine 90 mg;P2 Group：pentazocine 150 mg;P3 Group： pentazocine 180 mg;F group： fentanyl 0.4 mg.Above treatment in four groups were combined with 0.2% ropivacaine for epudiral analgesia.The VAS score,Ramsay sedation score,PCA pumps push the number of patients（D1） and the actual entry number（D2）,the ratio of nausea and vomitting,were recorded.Results： The VAS score of P1 group at each time point was higher than those of P2,P3 and F group（P0.05）.The VAS scores of P2 and P3 group at each time point were higher than that of F group（although P0.05）.The Ramsay sedation scores of P2 group at 4 h,8 h and 12 h after operation were higher than that of P1 group（P0.05）.The Ramsay sedation score of P3 and F group at each time point were higher than that of P1 group（P0.05）.The Ramsay sedation score of P3 and F group at 8 h,12 h and 24 h after operation were higher than that of P2 group（P0.05）.The D1/D2 ratios of P1 group at 8 h,12 h and 24 h after operation were higher than those of P2,P3 and F group（P0.05）.The ratio of nausea and vomiting of F group were higher than that of P2 and P3 group（P0.05）.Conclusions： 150 mg pentazocine combined with 0.2% ropivacaine for epudiral analgesia after abdominal hysterectomy is more effective,with lower incidence of adverse reactions,suggesting that it is relatively safe and effective technique for epidural analgesia.