罗哌卡因硬膜外持续输注在肝肿瘤射频消融术中的镇痛效果

Analgesic efficacy of continuous epidural Infusion of 0.2% ropivacaine for patients of liver neoplasms undergoing percutaneous radiofrequency ablation

目的观察经皮肝肿瘤射频消融术中罗哌卡因持续硬膜外输注的镇痛效果。方法 90例肝肿瘤患者给予0.2%罗哌卡因硬外麻醉,首量10 m L,持续硬外泵注,随机分3组,每组30例。A组为4 m L·h^(-1) ;B组为6 m L·h^(-1) ;C组为8 m L·h^(-1) 。记录患者T0(术前)、T1(切皮)、T2(消融)、T3(术毕)时MAP、HR、Sp O2、ADR和视觉模拟评分(VAS)。结果与A组比较,B组、C组患者于T2、T3时MAP、HR、VAS评分显著降低(P<0.05),C组心动过缓例数明显增多(P<0.05);与B组比较,C组患者T1、T2、T3时MAP、HR、ADR显著降低(P<0.05)。结论 0.2%罗哌卡因4 m L·h^(-1) ,6 m L·h^(-1) ,8 m L·h^(-1) 连续硬膜外注射改善射频消融患者镇痛效果,6 m L·h^(-1) 的剂量镇痛更有效更安全。

Objective To observe the analgesic efficacy of continuous epidural infusion of 0. 2%ropivacaine in patients with liver neoplasmsundergoing percutaneous radiofrequency ablation. Methods After10 m L of epidural bolus 0. 2% ropivacaine,90 patients with liver neoplasms undergoing percutaneous radiofrequency ablation performed under epidural anesthesia by continuous infusion with three different doses of 0. 2% ropivacaine were randomly divided into 3 groups,30 cases in each group： Group A were given 4 m L·h^（-1） ropivacaine; Group B were given 6 m L·h^（-1） ropivacaine; Group C were given 8 m L·h^（-1） ropivacaine.MAP,HR,Sp O2,ADR and visual analogue scale（ VAS） of all patients at time of T0（ before operation）,T1（ incision）,T2（ ablation）,T3（ after operation） were recorded. Results Compared with Group A,MAP,HR,VAS of patients in Group B,Group C at time of T2 and T3 were decreased significantly（ P 0. 05）,and the incidence of bradycardia of patients in group C were significantly increased（ P 0. 05）; compared with Group B,MAP,HR,ADR of patients in Group C at time of T1,T2,T3 were decreased significantly（ P 0. 05）,the difference was statistically significant. Conclusion The use of continuous epidural infusions of 0. 2% ropivacaine at 4 m L · h^（-1） ,6 m L · h^（-1） ,8 m L · h^（-1） improved analgesic efficacy in patients undergoing percutaneous radiofrequency ablation. The dose of 6 m L·h^（-1） has more effective and safe analgesic effects than either of the other drugs alone for patients of liver neoplasms undergoing percutaneous radiofrequency ablation.