罗哌卡因与布比卡因复合吗啡术后镇痛效果及副反应临床观察

Comparison the quality of analgesia and the side-effects in the use of a continuous epidural infusion of ropivacaine alone and bupivacaine in combination with morphine

目的 比较罗哌卡因和布比卡因复合吗啡术后镇痛的临床效果及其副反应。方法 5 0例择期手术患者 ,随机、双盲分成两组 :R组及B组 ,每组 2 5例。R组使用 2g/L罗哌卡因 ,B组使用 1 12 5 g/L布比卡因复合 0 0 3g/L吗啡 ,以 2ml/h的速度术毕予硬膜外腔连续输注 ,药量均为 112 5ml。观察镇痛、生命体征变化及瘙痒、呕吐、尿潴留等不良反应发生率。结果 两组术后生命体征的变化 (除术后 6h采样点外 )、镇痛药的使用、瘙痒发生率均无统计学差异性 (P>0 0 5 )。R组视觉模拟评分法评分显著大于B组 (P <0 0 5 )。而两者的呕吐、尿潴留发生率相比 ,具有显著统计学差异性 (P <0 0 5 )。结论 2 g/L罗哌卡因和 1 12 5g/L布比卡因复合 0 0 3g/L吗啡 ,以 2ml/h的速度硬膜外腔连续输注 ,其术后生命体征变化几无差异 ;镇痛效果前者略差 ,但前者的呕吐、尿潴留的发生率较后者明显减少 (P <0 0 5 )。

Objective To compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous epidural infusion of 2 g/L ropivacaine alone and 1.125 g/L bupivacaine in combination with 0.03 g/L morphine with the total volume 112.5 ml each. Methods 50 patients undergone selective surgery were divided into two groups by the randomized, double-blinded method, twenty-five each: ropivacaine group (R) and bupivacaine group (B). Patients of group R received a 56 h continuous epidural infusion (2 ml/h) of 2 g/L ropivacaine and the ones of group B got 1.125 g/L bupivacaine with the same speed immediately after the operation. Visual analogue scale (VAS) scores for pain, the variation of the vital signs and adverse effects including pruritus, vomiting and retention of urine were recorded. Results The mean visual analogue scale (VAS) scores for pain were higher in the groups R (P<0.05). The incidence of vomiting and retention of urine were significantly higher in the groups B (P<0.05). The variation of vital signs of the 2 groups had no statistical significance except for the record at the moment of 6 hours after operation. Conclusion A continuous, epidural infusion with 2 g/L ropivacaine alone and 1.125 g/L bupivacaine in combination with 0.03 g/L morphine was safe and effective for analgesia. 2 g/L ropivacaine appeared better because of the low incidence of vomiting and retention of urine in spite of less efficiency of analgesia.