氢吗啡酮联合罗哌卡因用于妇科术后自控硬膜外镇痛

Postoperative epidural analgesia with hydromorphone combined ropivacaine in patients underwent gynecologic surgery

目的探讨氢吗啡酮联合罗哌卡因用于妇科术后自控硬膜外镇痛（PCEA）的可行性以及不良反应。方法120例妇科经硬膜外麻醉行手术治疗且要求术后镇痛的患者，随机分为三组，每组40例。三组手术、麻醉方法相同，均在手术结束时行PCEA治疗。镇痛液配方：H组氢吗啡酮4μg·mL^-1，HR组氢吗啡酮4μg·mL^-1＋罗哌卡因1mg·mL^-1，MR组吗啡40μg·mL^-1罗哌卡因1mg·mL^-1组。评价术毕2h（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）、36h（T6）、48h（T7）时患者静态、动态疼痛视觉模拟量表评分（VAS）和Ramsay镇静评分，记录自控按压次数及不良反应的发生情况。结果T1～T4时H组患者静态疼痛VAS高于HR组和MR组（P〈0．05），HR组与MR组各时间点静态疼痛VAS比较差异均无显著意义（P〉0．05）；三组术后各观察时点动态VAS和Ramsay镇静评分比较差异均无显著意义（P〉0．05）。H组患者自控按压次数多于HR组和MR组（P〈0．05），后两组无显著差异（P〉0．05）。MR组瘙痒、恶心、呕吐发生率均高于其他两组，且术后肛门首次排气时间延长（P〈0．05），H组与HR组间无显著差异（P〉0．05）。结论氢吗啡酮联合罗哌卡因用于妇科术后PCEA能获得更为满意的镇痛效果，且不良反应少。

AIM To investigate the feasibility and adverse reactions of hydromorphone combined with ropivacaine on postoperative patient controlled epidural analgesia （PCEA） in patients underwent gynecologic surgery. METHODS One hundred and twenty patients scheduled for selective gynecologic surgery with epidural anesthesia were randomized into three groups, with 40 patients each. All patients were received the same method of anesthesia and surgery. PCEA was used with hydromorphone 4μg·mL^-1 in group H, hydromorphone 4μg·mL^-1 plus ropivacaine 1 mg·mL^-1 in group HR, and morphine 40 μg·mL^-1 plus ropivacaine 1 mg·mL^-1 in group MR. Static visual analog scale （VAS） pain scores, dynamic VAS pain scores, Ramsay scores at 2 h （T1）, 4 h （T2）, 8 h （T3）, 12 h （T4）, 24 h （T5）, 36 h （T6）, 48 h （T7） after the operation were recorded respectively. PCEA pushing and adverse reactions were observed and analyzed. RESULTS The static VAS pain scores of the group H were higher than the group HR and group MR at TI - T4 （P 〈 0.05）, but the difference between the group HR and group MR was not significant at each time point （P 〉 0.05）. There was no significant difference in dynamic VAS pain scores and Ramsay scores in those three groups at each time point （P 〉 0.05） . The number of PCEA pushing times in the group H was significantly higher than the group HR and group MR （P 〈 0.05）, and there was no significant difference between the latter two groups （P 〉 0.05）. The incidence of pruritus, nausea and vomit in the group MR were higher than other groups, and the first flatus was later （P 〈 0.05）. There was no significant difference between the group H and group HR （P 〉 0.05） . CONCLUSION Hydromorphone combined with ropivacaine is effective and safe for postoperative PCEA in patients underwent gynecologic surgery, and with less adverse reactions.