不同浓度盐酸罗哌卡因复合芬太尼用于硬膜外镇痛对尿潴留的影响

Different concentrations of ropivacaine hydrochloride and fentanyl epidural analgesia on urinary retention

目的：比较不同浓度的盐酸罗哌卡因复合芬太尼用于术后硬膜外镇痛对尿潴留的影响。方法：选择择期行腹股沟区手术患者90例，ASAⅠ～Ⅱ级，其中无张力斜疝修补术62例，鞘膜翻转术28例。行持续硬膜外麻醉，术毕开始PCEA，镇痛时间为48h。根据PCEA配药方案不同，随机分为三组，每组30例：A组0．075％罗哌卡因＋2μg／mL芬太尼；B组0．113％罗哌卡因＋2μg/mL芬太尼：C组0．150％罗哌卡因＋2μg／mL芬太尼。PCEA设置：负荷量5mL，维持量2mL／h，bolus4mL／次，锁定时间为15min，极限量12mL/h。镇痛开始后4h、8h、24h、36h随访，观察36h累计用药量，各时间点VAS评分、运动阻滞改良Bromage评分、心率（HR）、血压（MBP）、氧饱和度（Sp02）、发生尿潴留安置尿管例数以及其他不良反应。结果：A组36h用药量显著大于B组和C组，P〈0．05．B组与C组比较，P〉0．05；VAS评分，A组显著高于B组和C组，P〈0．05，B组与C组比较，P〉0．05；改良Bromage评分，C组显著高于A组和B组，P〈0．05，B组与A组比较，P〉0．05；尿潴留安置尿管例数，分别为0、1、5例，C组显著高于A组和B组，P〈0．05，B组与A组比较．P〉0．05；HR、MBP、SpO2及其他副反应无显著差异，P〉0．05。结论：0．113％盐酸罗哌卡因＋2μg／mL芬太尼硬膜外镇痛止痛效果确切．不产生明显运动阻滞，几乎无尿潴留发生。

Objective：Different concentrations of ropivacaine hydrochloride and fentanyl affect the postoperative epidural analgesia on urinary retention. Methods elective inguinal surgery 90 patients, ASA Ⅰ-Ⅱstage in which tension-free inguinal hernia repair in 62 cases, 28 cases of hydrocele turnover operation. Line continuous epidural anesthesia, surgery began PCEA, analgesia time was 48h. According PCEA dispensing schemes, were randomly divided into three groups of 30 cases： A group of 0.075% ropivacaine ＋ 2p, g/mL fentany]; group B 0.113% ropivacaine ＋ 2μg/mL fentanyl; group C 0.150% ropivacaine ＋ 2p, g/mL fentanyl. PCEA settings： load 5mL, maintenance dose of 2mL/h, bolus 4mL/time, lock time 15rain, limit the amount of 12mL/h. 4h, 8h, 24h, 36h follow-up of 36 hours total dosage, VAS scores at each time point, motor block modified Bromage score, heart rate （HR）, blood pressure （MBP）, oxygen saturation after beginning analgesia （SpO2）,the number of cases of catheter placement urinary retention and other adverse reactions. Results A group 36h treatment was significantly higher than group B and group C, P〈0.05, group B and group C, P〉 0.05 ; VAS score, A group was significantly higher than that in group B and group C, P〈0.05, group B and C group, P〉0.05; modified Bromage score, group C was significantly higher than that in group a and group B, P〈0.05, group B and group a, P〉0.05; the number of cases of urinary retention catheter placement, respectively 0, 1,5. patients in group C was significantly higher than that in group a and group B, P〈0.05, group B and group a, P〉0.05; HR, MBP, SpO2 and other side effects was no significant difference, P〉0.05. Conclusion 0.113% ropivacaine hydrochloride ＋ 2μg/mL fentany] analgesic effect of epidural analgesia exact, it does not produce significant motor block, almost no incidence of urinary retention.