低含量罗哌卡因复合芬太尼自控镇痛用于急性腰腿痛的临床研究

Clinical study on patient control epidural analgesia with low concentration ropivacaine combined with fentanyl for acute low back pain

目的:观察0.75和1g/L两种含量的罗哌卡因复合1mg/L芬太尼行硬膜外自控镇痛(PCEA)治疗急性腰腿痛的疗效。方法:30例急性腰腿痛患者抽签法随机分为A组:0.75g/L的罗哌卡因复合芬太尼和B组:1g/L罗哌卡因复合芬太尼,对两组患者治疗前、PCEA治疗1,6h,1d以及术后第7天几个时间段,采用双肓法分别对视觉模拟评分、BCS舒适评分、下肢运动神经阻滞的评分以及患者的生命体征、阻滞平面、睡眠质量以及是否出现恶心呕吐、皮肤瘙痒、呼吸抑制和排尿功能异常等并发症进行观察。结果:A和B两组患者镇痛效果均非常满意,BCS舒适评分在治疗后也明显增加,但两组之间无明显差异,A组患者无下肢运动神经阻滞的现象,B组有20%(3/15)的患者有轻度的运动神经阻滞及排尿困难,两组间差异有显著意义(P<0.05),两组患者生命体征平稳,无呼吸抑制,其阻滞平面、恶心呕吐、皮肤瘙痒等并发症较少,两组间无显著差异(P>0.05)。结论:0.75g/L的罗哌卡因复合1mg/L芬太尼对急性腰腿痛患者既达到有效的镇痛又不影响患者的生活质量。

AIM:To observe the effectiveness produced by 0.75 g/L or 1 g/L ropivacaine combined with fentanyl 1 mg/L in patient control epidural analgesia(PCEA) for acute low back pain. METHODS:The double blind, randomized study was performed in 30 patients with acute low back pain who received PCEA.After a lumbar epidural catheter had been placed,group A received 0. 75 g/L ropivacaine combined with fentanyl 1 mg/L,group B received 1 g/L ropivacaine combined with fentanyl 1 mg/L.PCEA included:①loading dose 4 mL of 2 g/L ropivacaine combined with 7mg diprospan. ②background infusion 3-4 mL.③a bolus of 2 mL with a 15 min.④the total infusion solution 100 mL.Visual analogue pain scores,Bruggrmann Comfort Scale(BCS), Modified Bromage Score(MBS),level of sensory block and side effects of PCEA were recorded 1,6 hours,1 and 7 days after operation. RESULTS:All patients showed good analgesia.No differences were observed between the two groups for pain scores,BCS and level of sensory block.Motor function didn't affect in group A,the patients got 6 scores of MBS.Three patients' motor and micturition function decreased in group B(20%decrease,significant difference compared with group A,P< 0.05).The incidence of other side effects(nausea and vomit,skin itching) were the same between group A and B(P >0.05). CONCLUSION:PCEA with 0.75 g/L ropivacaine combined with 1 mg/L fentanyl is effective on analgesia and has no side effects on the quality of life in patients with acute low back pain.