摘要
目的观察不同浓度罗哌卡因配伍地左辛用于下腹PCEA的镇痛效果、运动阻滞的临床观察。方法选择60例ASAI-Ⅱ级患者采用硬膜外镇痛患者随机分为3组，每组20例。分别予以地佐辛5mg＋0．125％的罗哌卡因＋生理盐水稀释至100ml（D1组）、地佐辛5mg＋0．175％罗哌卡因＋生理盐水稀释至100ml（D2组）、地佐辛5mg＋0．225％罗哌卡因＋生理盐水稀释至100ml（D3组）进行硬膜外镇痛。利用LCP模式给药，首次给药剂量5ml，持续剂量2mL／h，锁定时间为20min，全程镇痛48h，观察和记录患者术后镇痛开始后2、4、12、24、48h视觉模拟法（VAS）评分、Bromage改良运动评分，术后活动能力，术后恶心、呕吐等不良反应发生情况。结果3组患者年龄，性别比例，体质量，手术时间和术中出血量等差异均无统计学意义（P均〉0．05）。术后2、4、12h，D2组、D3组VAS评分明显低于D1组[（2．54±1．34）、（2．47±1．05）分与（3．62±1．02）分，（2．13±1．30）、（2．15±1．28）分与（3．56±1．10）分，（1．03±0．43）、（1．04±0．51）分与（1．92±1．2．0）分]差异均有统计学意义（P均〈0．05）。3组Bromage改良运动评分比较，D1组与D2组各时点比较差异均无统计学意义（P均〉0．05），且D1组与D2组Bmmage各时点改良运动评分明显低于D3组[（1．21±0．21）、（1．28±0．22）分与（1．53±0．31）分，（1．15±0．15）、（1．44±0．25）分与（1．61±0．12）分，（0．92±0．14）、（0．99±0．13）分与（1．71±0．22），（0．85±0．11）、（O．88±0．14）分与（1．66±0．15）分，（0．42±0．10）、（0．55±0．09）分与（1．19±0．11）分]（P均〈0．05）。3组分别出现2例，2例，3例恶心呕吐（P〉0．05），无其他不良反应。结论0．175％罗哌卡因配伍地寿辛5mK用于下腹手术后镇痛效果满意．且有利于患者早期下床活动。
Objective To investigate the analgesic effect and motor block of ropivacayin combined dezocine in lower abodiminal operation. Methods Sixty patients of ASA I - 0 were divided into three groups randomly（ n = 20 for each group）. They were treated with dezocine 5 mg ＋ 0. 125% ropivacayin/100 ml（ group D1 ） ,dezocine 5 mg ＋0. 175% ropivacayin/100 ml（group D2） ,dezocine 5 mg ＋0. 225% ropivacayin/100 ml （ group D3 ）. The initial dose was 5 ml, and the maintenance dose was 2 ml/h, with lock-out time of 20 mins, and the duration of patient-controlled epidermal analgesia （PCEA） was 48 h. The analgesic effect was evaluted by VAS score at 2,4,12,24 and 48 h after surgery. Bromage score and the side effects such as motor ability,and vomiting after surgery were recorded. Results At 2,4,12 h after surgery,the VAS scores of group D2 and D3 were less than that of group D1 （2. 54±1.34,2.47±1.05 and 3.62±1.02 at 2 hrs,2. 13±1.30,2. 15±1.28 and 3.56±1.10 at 4 hrs,1.03±0. 43,1.04±0. 51 and 1.92±1.20 at 12 hrs,respectively） （Ps 〈0.05）. As for the Bromage score among the 3 groups, there were no sighificant diffrences between group D1 and D2,wheras they were significantly lower than that in group D3 （ 1.21±0. 21,1.28±0. 22 and 1.53±0. 31 at 2 hrs,1.15 2 0. 15,1.4±0.25 and 1.61±0. 12 at 4 hrs,O. 92±0. 14,0.99±0. 13 and 1.71 20.22 at 12 hrs,0. 85±0.11,0.88 20. 14 and （1.66±0.15） at 24 hrs,0.42 20.10,0.55±0.09 and 1.19±0,11 at 48 hrs, respectively,Ps 〈 0. 05）. There were 2,2 and 3 patients affected with nausea and vomiting among the 3 groups, and there were no other side effects （P 〉 0. 05 ）. Conclusion 0. 175% ropivacayin combined with dezocine 5 mg via PCEA in lower abodiminal operation shows better analgesic effect and benefical to the restoration of lower limbs movements.
出处
《中国综合临床》
2012年第7期739-741,共3页
Clinical Medicine of China
