罗哌卡因在悬雍垂腭咽成形术中的镇痛作用

Application of ropivacaine in uvulopalatopharyngoplasty

目的观察在悬雍垂腭咽成形术(UPPP)中镇痛药物应用甲磺酸罗哌卡因的安全性及有效性。方法择期全麻下UPPP患者80例,随机分成0.15%罗哌卡因镇痛组(A组,20例),0.3%罗哌卡因镇痛组(B组,20例),0.6%罗哌卡因镇痛组(C组,20例)与安慰剂对照组(D组,20例)。A、B、C组在经鼻插管全身麻醉下行悬雍垂腭咽成形术前,于舌腭弓扁桃体下缘分别注射0.15%、0.3%、0.6%甲磺酸罗哌卡因4 mL,咽腭弓上部、舌腭弓扁桃体上缘及中缘局部各分别注射2 mL,计20 mL。D组于上述部位局部浸润注射生理盐水共计20 mL。各组在术后均持续监测患者血氧饱和度、呼吸、血压、心电图,记录术后2、4、6、12、24、48 h的VAS评分、Ramsay评分和术后额外镇痛药使用情况及不良反应发生情况。结果 A组术后6 h内的VAS评分低于D组(P<0.05);B、C组术后48 h内的VAS评分低于D组(P<0.05);4组患者各时间点Ramsay评分差异无统计学意义(P>0.05);A、B、C三组额外镇痛药使用次数少于D组(P<0.05);C组有3例吞咽不畅,D组有4例出现吞咽困难,4组患者其余不良反应发生情况差异无统计学意(P>0.05);结论罗哌卡因对悬雍垂腭咽成形术患者具有良好的镇痛效果,0.3%罗哌卡因的效果更佳,具有较好的安全性。

Objective To evaluate the safety and effectiveness of ropivacaine mesylate in uvulopalatopharyngoplasty （UPPP）. Methods Based on the concentration of ropivacaine applied in the operation, 80 UPPP patients were divided randomly into group A （0.15% ropivacaine）, B （0.3% ropivacaine）, C （0.6% ropivacaine） or D （no ropi- vacaine but placebo）. Each group consisted of 20 cases. Under general anesthesia, 4M1 of corresponding ropivacaine mesylate were injected into the lower part of palatoglossal arch, while upper and middle parts of palatoglossal arch and upper part of palatopharyngeal arch were infiltrated with 2ml ropivacaine, respectively. For the group D, no ropi- vacaine but normal saline were applied. Postoperative blood oxygen saturation, breathing, blood pressure and electro- cardiogram were monitored , as well as visual analogue scale score （VAS）, Ramsay sedation score, use of analgesics at 2,4,6,12,24 and 48hours after the operation. Results VAS score of group A was lower than that of group D at 6th hours after the operation（ P 〈 0.05 ） ; VAS score of Group B and C were lower than that of group D at 48th hours （ P 〈 0.05 ） ; Ramsay sedation scores of the four groups were not significantly different; The usage of analgesics in group A, B and C all were lower than group D （ P 〈 0.05 ）. In three patients in group C and four in group D, swallowing disorder were noted. No difference of side-effects among the four groups were significant. Conclusion Ropivacaine shows satisfying pain control and safety in uvulopalatopharyngoplasty, esp. 0.3% ropivacaine.