罗哌卡因地塞米松及吗啡混合液用于硬膜外术后镇痛的研究

Study of postoperative epidural analgesia with mixture of Ropivacaine, Dexamethasone and Morphine

目的 研究罗哌卡因地塞米松及吗啡混合液用于硬膜外术后镇痛的时效。方法选择ASA1～2级择期子宫切除术患者80例,随机分为4组,每组20例。Ⅰ组手术结束时硬膜外单次注入0.25％罗哌卡因6 mL;Ⅱ组硬膜外单次注入0.25％罗哌卡因6 mL(内含地塞米松10 mg);Ⅲ组硬膜外单次注入0.25％罗哌卡因6mL(内含地塞米松10mg+吗啡2mg);Ⅳ组用患者自拉硬膜外镇痛(PCEA)泵,镇痛药液为0.1％罗哌卡因和0.04mg/mL吗啡,背景速度2mL/h,PCA剂量0.5mL,锁定时间15 min,采用PCEA泵持续镇痛呈术后72 h。记录患者术后(72 h内)手术部位出现疼痛及下肢运动功能恢复的时间,以及恶心呕吐及皮肤瘙痒等不良反应的发生率。结果 与Ⅰ组比改,Ⅱ组术后无痛状态的持续时间显著延长(P<0.05);Ⅲ组、Ⅳ组术后无痛状态的持续时间均超过72 h,与Ⅰ组比较,有非常显著性差异(P<0.01)。各组术后下肢运动功能恢复的时间无显著性差异(P>0.05)。结论 罗哌卡因及地塞米松与吗啡混合液单次注射用于硬膜外术后镇痛,不管是否应用PCEA泵持续输注,均能获得良好和持久的镇痛效果。

Objective It is to study the analgesic duration of epidural analgesia with Ropivacaine, Dexamethasone and Morphine after hysterectomy. Methods Eighty patients were randomly divided into four groups. In group I 0.25% Ropivacaine 6 mL was injected to epidural space. In group II 0.25% Ropivacaine, which included Dexamethasone 10 mg, was injected. In group Ⅲ 0. 25% Ropivacaine 6 mL, which included Dexamethasone 10 mg and Morphine 2 mg, was used. In group Ⅳ 0.1% Ropivacaine and Morphine 0.04 g/L were used for patients continuous epidural analgesia (PCEA). PCEA was lasting for 72 hours. The occurrence of pain and the recovery of crura movement function were observed. Results The postoperative analgesia duration of group Ⅱ was longer than that of group Ⅰ . The postoperative analgesia durations of group Ⅲ and group Ⅳ were more than 72 hours and it showed significant difference compared with that of group Ⅰ (P<0.01). But the recovery time of crura movement function of four groups have no significant difference (P>0.05). Conclusion The combination of Ropivacaine, Dexamethasone and Morphine can produce longer postoperative analgesia duration and that is independent of PCEA.