罗哌卡因硬膜外持续输注下氯诺昔康PCIA的临床效应

Analgesic effect of continuous epidural infusion of ropivacaine supplemented by patient-controlled intravenous analgesia with lornoxicam after hysterectomy

目的 研究硬膜外持续输注罗哌卡因期间氯诺昔康静脉PCA的临床效应和不良反应,并以吗啡对照比较。方法 选择60例(ASAⅠ～Ⅱ)妇科经腹子宫全切手术病人,随机分为L组与M组,双盲观察,均采用双泵行PCA治疗。其PCA设置为Bolus 1ml/次,锁定时间为5min,1h限量12ml。镇痛效果和副作用评定:(1)采用视觉模拟评分(VAS),0为无痛、10为剧痛。(2)BCS舒适评分。(3)病人对PCA总体印象评分。(4)记录可能出现的并发症和不良反应。结果 两组病人的一般情况相似,24h硬膜外罗哌卡因使用剂量均为192mg,L组与M组未按压PCA泵的病人各为5例(21.7％),静脉PCA用药剂量分别为(3.4±2.8)mg(L组)和(4.7±3.5)mg(M组),两药用量比值为1:1.4(P>0.05);相同时间段内两组间VAS、BCS、Bromage评分及D1/D2比值均无统计学差异。结论0.2％罗哌卡因硬膜外持续输注(4ml/h)能明显减少静脉PCA用量,新型非甾体类抗炎药氯诺昔康与吗啡静脉用药效价相似,但氯诺昔康对病人恶心呕吐的不良反应具有明显减少的优点。

Objective To compare the analgesic and side effects of patient-controlled intravenous analgesia(PCIA) with lornoxicam and morphine supplemented by continuous epidural infusion of 0.2% ropivacaine. Methods Sixty ASA I - II patients undergoing elective hysterectomy under epidural anesthesia were randomly divided into two groups: lornoxicam group (L, n = 30) and morphine group (M, n=30). For postoperative analgesia both groups received continuous epidural infusion of 0.2% ropivacaine 4 ml'h . In group L the patients received PICA with 0.008% lornoxicam and in group M 0.001% morphine. The bolus dose was 1 ml, lock-out interval 5 min and maximal amount within 1 h was 12 ml in both groups. If the patient still felt pain after pressing PCA pump 12 times, an additional epidural bolus of 0.2% ropivacaine 5 ml and morphine 0. 5mg was given. The clinical effects were assessed by (1) VAS score of pain( 0 = no pain, 10 = severe pain), (2) Bruggrmann comfort score (0 = persistent pain, 4 = no pain at coughing), (3) modified Bromage score, (4)patients satisfaction, (5) the number of pressing of PCIA pump by the patient (D1 ) at 30 min, 1,4,8,12,16,20,24h and the number of bolus dose delivered (D2), (5) the time when the patient passed gas and (7) complications such as nausea and vomiting and respiratory depression.Results The demographic data were comparable between the two groups. The amount of ropivacaine consumed was 192 mg in both groups.The amount of lornoxicam consumed was (3.4 +2.8) mg in group L and the amount of morphine consumed was (4.7 + 3.5) mg in group M. There was no statistically significant difference in VAS and Bruggrmann comfort score between the two groups. There were less side-effects in group L which were also milder as compared with those in group M.Conclusion The results suggest that continuous epidural infusion of 0.2% ropivacaine combined with lornoxicam in PCIA can provide better analgesia and reduce drug consumption in PICA. The efficacy of analgesia providedby lornoxicam is similar to morphine but lornoxicam causes less side-effects than morphine.