不同浓度罗哌卡因复合舒芬太尼用于开胸术后硬膜外镇痛的临床研究

Different Concentrations of Ropivacaine Combined With Sufentanil During Post-Thoracotomy Epidural Analgesia

目的比较不同浓度罗哌卡因复合舒芬太尼用于开胸术后硬膜外镇痛效果和不良反应的影响。方法选择择期开胸手术患者90例,ASAⅠ～Ⅱ级,术后均采用硬膜外连续输注自控镇痛,随机分为A组（0.1%罗哌卡因＋0.2μg/ml舒芬太尼）,B组（0.15%罗哌卡因＋0.2μg/ml舒芬太尼）,C组（0.2%罗哌卡因＋0.2μg/ml舒芬太尼）,总容量均为250 ml,背景剂量为5 ml/h,单次给药剂量2ml,锁定时间15 min。分别记录三组患者48 h的VAS评分和不良反应及血气分析情况。结果 A组和B组的不良反应的差异无统计学意义（P〉0.05）,但是A组的VAS评分明显高于B组（P〈0.05）,且血气分析结果（p H、Pa O2和Pa CO2）,B组优于A组（P〈0.05）。B组和C组的VAS评分的差异无统计学意义（P〉0.05）,但是C组的不良反应发生率明显高于B组（P〈0.05）,同时血气分析结果（p H、Pa O2和Pa CO2）,B组优于C组（P〈0.05）。结论 0.15%罗哌卡因＋0.2μg/ml舒芬太尼用于开胸手术术后硬膜外自控镇痛不但可以获得满意的镇痛效果,同时副作用最少,对呼吸功能影响最小。

Objective To compare the effect and adverse reactions of different concentrations of Ropivacaine combined with sufentanil used for Post-thoracotomy epidural analgesia. Methods Chose 90 patients who undergoing elective thoracotomy surgery, ASA Ⅰ ～ Ⅱ, postoperative adopt continuous epidural infusion self-control analgesia, and randomly divided into group A（0.1% Ropivacaine ＋ 0.2 μg/ml Sufentanil） and group B（0.15% Ropivacaine ＋ 0.2 μg/ml Sufentanil）, group C（0.2% Ropivacaine ＋ 0.2 μg/ml Sufentanil）, the total capacity was 250 ml, background dose was 5 ml/h, single drug dose was 2 ml, locking time was 15 min. Recorded three groups of patients with 48 h VAS score and blood gas analysis and adverse reactions. Results The adverse reaction in group A and group B had no significant difference（P〉0.05）,but the VAS score in group A was obviously higher than that in group B（P〈0.05）, and blood gas analysis results（PH, Pa O2 and Pa CO2） in group B was better than group A（P〈0.05）. VAS scores in group B and group C had no significant difference（P〈0.05）, but the incidence of adverse reactions in C group was obviously higher than that in group B, blood gas analysis（PH, Pa O2 and Pa CO2） in group B were better than group C（P〈0.05）. Conclusion 0.15% Ropivacaine ＋ 0.2 μg/ml sufentanil for postoperative epidural controlled analgesia after thoracotomy not only can obtain satisfactory analgesia effect, but also the has minimum side effects and the minimum impact on the respiratory function at the same time.