舒芬太尼复合甲磺酸罗哌卡因用于妇科术后硬膜外镇痛的观察

Observation of the epidural analgesia effect of sufentanyl combined with ropivacaine mesylate on patients after gynaecological surgery

目的:观察舒芬太尼复合甲磺酸罗哌卡因或左旋布比卡因用于妇科术后硬膜外镇痛的效果。方法:选择56例ASAⅠ～Ⅲ级行妇科手术后需进行术后硬膜外镇痛的患者,随机分成2组,R组(n=28):舒芬太尼2μg/kg+甲磺酸罗哌卡因178mg+氟哌利多2mg;B组(n=28):舒芬太尼2μg/kg+左布比卡因125mg+氟哌利多2mg,均加0.9%NS至100ml注入一次性镇痛泵。两组均以LCP模式输注,接镇痛泵前给予甲磺酸罗哌卡因29.8mg负荷量,背景剂量2ml/h,锁定时间15min。观察并记录患者术后6,12,24,48h的MAP,HR,RR,SpO2、VAS评分、肛门排气时间、Bromage分级达0级的时间及恶心呕吐、低血压、呼吸抑制等不良反应。结果:术后镇痛评分的4次测量间差异存在统计学意义(P<0.05);镇痛评分在两组间成对比较,无显著性差异(P>0.05),两组患者术后SpO2、HR、MAP、RR、肛门排气时间、恶心呕吐、低血压比较,无显著性差异(P>0.05)。术后Bro-mage分级恢复达0级的时间比较,存在显著性差异(P<0.05)。结论:舒芬太尼复合0.178%甲磺酸罗哌卡因用于妇科术后硬膜外镇痛效果满意,运动阻滞更轻,肌力恢复得更快,不良反应少,值得推广应用。

Objective： To observe the epidural analgesia effect of sufentanyl combined with ropivacaine mesylate or levobupivacaine on patients after gynaecological surgery.Methods： 56 ASA I-III patients who underwent postoperative epidural analgesia after gynecological surgery were randomly divided into two groups,group R and B.Patients in group R（n=28） were treated with sufentanil（2 μg Kg）,ropivacaine mesylate（178 mg） and droperidol（2 mg）;while patients in group B（n=28） were with sufentanil（2 μg Kg）,levobupivacaine（125 mg） and droperidol（2 mg）,all were added 0.9% NS to 100 ml,then they were injected into a one-time analgesia pump.Both groups were infused in LCP mode.Patients were given ropivacaine mesylate 29.8 mg as the loading dose before connecting with the pump analgesia,background dose of 2 ml h,and the lock time was 15 min.MAP,HR,RR,SpO2,VAS scores,anal flatus time,time of Bromage grading back to zero,nausea or vomit,hypotension,respiratory suppression and other adverse reactions of the patients were observed and recorded 6 h,12 h,24 h and 48h respectively after surgery.Results： There was of statistical difference between the postoperative pain scores of 4 measurements（P0.05）,while no statistical difference between the two groups in analgesic score（P0.05）,and no significant difference in postoperative SpO2,HR,MAP,RR,anal flatus time,nausea,vomiting and hypotension,either（P0.05）.There was of statistical difference in Bromage grading recovery time of zero（P0.05）.Conclusion： The epidural analgesia effect of sufentanil combined with 0.178% ropivacaine mesylate after gynecological surgery is satisfactory,with the advantages of motion block lighter,faster muscle recovery,fewer adverse reactions.Therefore,it should be introduced and widely applied.