不同容量在硬膜外镇痛辅助膝关节锻炼中对镇痛效果的影响

EFFECT OF DIFFERENT CAPACITY OF ROPIVACAINE USE IN EPIDURAL ASSISTED KNEE REHABILITATION EXERCISES

目的：观察硬膜外镇痛辅助膝关节锻炼时不同容量对镇痛效果的影响。方法：选择需延迟锻炼的膝周围骨折术后患者75例，术后2周硬膜外镇痛辅助下肢功能锻炼，根据背景流量随机分为3组：A组25例，2ml／h；B组25例，3ml／h；C组25例，4ml／h。自控量均为2ml／次，锁定时间20min。镇痛液配比均为0．25％罗哌卡因＋舒芬太尼0．4ug／ml＋格雷司琼30ug／ml。每日下肢关节功能康复器（continue passive motion，CPM）锻炼2次，并鼓励患者自主锻炼，首次CPM前硬膜外予0．5％罗哌卡因5～10ml预充，其后CPM前10min均予泵内药物4ml作为冲击量。观察不同时点或时段运动痛和静息痛，下肢运动阻滞和不良反应发生率。结果：B、C组间镇痛效果无统计学差异，均明显优于A组（P〈0．05），总按压次数与有效按压次数比值及PCA消耗量亦低于A组，但C组不良反应发生率明显高于A、B两组（P〈0．05），3组均无明显下肢运动阻滞，B组药物消耗量介于A、C组之间。结论：0．25％罗哌卡因＋舒芬太尼0．4ug／ml＋格雷司琼30ug／ml镇痛液，背景流量3ml／h，自控量2ml／次，CPM前配合适当预充量或冲击量，镇痛效果好，不良反应发生率低，有利于膝关节功能锻炼。

Objective： To observe the effect of different capacity of ropivacaine used in epidural analgesia aiding knee rehabilitation exercises. Methods： Seventy-five patients of fractures around the knee who need delay postoperative exercises were selected. Two weeks after operation, we designed epidural analgesia assisted lower-limb function training. They were randomly divided into three groups according to the analgesia pump flow： 25 patients in group A with flow volume of 2 ml/h; 25 patients in group B, with flow volume of 3 mlda; 25 patients in group C with flow volume of 4 ml/h. Patient-controlled volume was 2ml/order in three groups, patient-controlled interval was 20 min. The same drug ratio was used in three groups, 0.25% ropivacaine＋ sulfentanyl 0.4 ug/ml ＋ granisetron 30 ug/ml. The daily continue passive motion （ CPM ） exercises 2 times, and encourage patients to exercise by themselves in resting times. Before the first CPM exercise, we gave 0.5% ropivacaine epidural 5-10 ml as pretreatment at the first time. Ten min before the following each CPM function exercise, we gave 4 ml injection from the PCA pump. The level of pain was observed when they take exercise and rest. also observed were motor function and other aversive side effects. Results： The analgesic effect of group B and group C is much better than group A （ P 〈 0.05 ） , there is no significant difference between group B and group C, the ratio of TPCA/EPCA of group B and group C is lower than group A. But the adverse reaction rate in C group was significantly higher than group A and group B （ P 〈 0.05 ） . No signitieant difference was observed in Motor function in the three groups. The Drug consumption of group B is between group A and group C. Conclusion： 0.25% ropivacaine＋sulfentanyl 0.4 ug/ml ＋ granisetron 30 ug/ml, flow volume 3 ml/h, patient-controlled volume 2 ml/order, supplemented with proper pretreatment or impaction before the CPM, could produce a good effect of analgesia and low incidence rate of side effects and it＇s good for functional exercise of knee joint.