罗哌卡因混合舒芬太尼用于混合痔外剥内扎术后患者自控硬膜外镇痛的配伍研究

Optimum compatibility of ropivacaine mixed with sufentanil for patient-controlled epidural analgesia after external dissection and internal ligation operation in patients with hemorrhoids

目的探讨罗哌卡因混合舒芬太尼用于混合痔外剥内扎术后患者自控硬膜外镇痛的适宜配伍。方法收集2019年10月至2020年6月在北京市二龙路医院择期行混合痔外剥内扎术患者120例,ASAⅠ或Ⅱ,年龄18~60岁,性别不限。于L3~4行腰硬联合麻醉,在蛛网膜下腔给予等比重盐酸罗哌卡因7.5 mg,向尾侧留置硬膜外导管。采用随机数字表法将患者随机分为4组,每组30例,镇痛配方分别是:A组0.1%罗哌卡因+舒芬太尼0.4μg/ml,B组0.075%罗哌卡因+舒芬太尼0.4μg/ml,C组0.075%罗哌卡因+舒芬太尼0.3μg/ml,D组0.075%罗哌卡因+舒芬太尼0.2μg/ml。稀释液均为0.9%NaCl注射液250 ml,背景速度5 ml/h,PCA 2 ml/次,锁定15 min。记录术后6、8、12、24、48 h的镇痛效果及不良反应。结果A、B、C组术后各时点VAS评分及48 h内PCA有效按压次数差异均无统计学意义(P均>0.05),且均优于D组(P均<0.05);B、C、D组改良Bromage评分差异均无统计学意义(P均>0.05),且均低于A组[(0.5±0.4)分、(0.5±0.4)分、(0.6±0.4)分比(2.6±0.5)分,P均<0.05];A、B组恶心呕吐发生率高于C、D组,差异均有统计学意义(P均<0.05)。结论0.075%罗哌卡因混合舒芬太尼0.3μg/ml为混合痔外剥内扎术后患者自控硬膜外镇痛的适宜配伍。

Objective To explore optimum compatibility of ropivacaine mixed with sufentanil for patient-controlled epidural analgesia after external dissection and internal ligation operation in patients with hemorrhoids.Methods A total of 120 patients underwent selective external dissection and internal ligation for patients with hemorrhoids,ASAⅠorⅡ,aged 18-60 years old,both sexes,at Beijing Erlonglu Hospital from October 2019 to June 2020.All patients received combined spinal-epidural anesthesia at the L3-4 space,and 7.5 mg of isobaric ropivacaine hydrochloride was injected into the subarachnoid space,catheter 3-3.5 cm was placed caudally.All patients were randomly divided into group A,B,C and D by random number table method,40 cases in each group.Patients were received 0.1%ropivacaine+sufentanil 0.4μg/ml in group A,0.075%ropivacaine+sufentanil 0.4μg/ml in group B,0.075%ropivacaine+sufentanil 0.3μg/ml in group C and 0.075%ropivacaine+sufentanil 0.2μg/ml in group D,then the medicine was diluted with 0.9%sodium chloride to 250 ml,with background speed 5 ml/h,PCA 2 ml/time and lock time 15 minutes.Analgesic efficacy and adverse reactions were recorded at 6,8,12,24,48 hours after the surgery.Results The analgesic effect had no statistical difference in group A,B and C(all P>0.05),and was significantly better than that in group D(all P<0.05).There was no significant difference in the Bromage score in group B,C and D(all P>0.05),which was significantly lower than that in group A[(0.5±0.4)scores,(0.5±0.4)scores,(0.6±0.4)scores vs.(2.6±0.5)scores,all P<0.05].The incidences of nausea and vomiting was significantly higher in group A and B than those in group C and D(all P<0.05).Conclusion Patient-controlled epidural analgesia with 0.075%ropivacaine and 0.3μg/ml sufentanil is the optimum compatibility and is more suitable for patients with hemorrhoids after external dissection and internal ligation operation.