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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 被引量:6

EFFECT OF DIFFERENT CAPACITY OF ROPIVACAINE USE IN EPIDURAL ASSISTED KNEE REHABILITATION EXERCISES
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摘要 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.
出处 《中国疼痛医学杂志》 CAS CSCD 北大核心 2014年第2期95-98,103,共5页 Chinese Journal of Pain Medicine
基金 桂林市科学研究与技术开发计划项目(20110502)
关键词 膝关节锻炼 镇痛 容量 效果 knee exercise analgesic capacity effect
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