硬膜外低浓度罗哌卡因伍用吗啡用于动脉硬化闭塞症血管内超声消融术后镇痛的研究

Analgesic Effect of Continuous Infusion of Ropivacaine and Morphine with Epidural Catheter Placed at ASO after UT

目的 用低浓度的罗哌卡因复合吗啡用于DSA下超声消融术治疗动脉硬化闭塞症术后硬膜外自控镇痛 ,以寻求较好的术后镇痛。方法 6 0例ASA1～ 2级超声消融术后病人 ,硬膜外导管分别留置于L2～ 3椎间隙 ,向上 3 0cm ,0 1 %罗哌卡因维持术中麻醉 ,将上述病人随机分为 2组 :实验组 0 0 75 %罗哌卡因加0 0 0 2 4吗啡加 0 0 0 2 %氟哌利多 ;对照组 0 0 0 4 %吗啡加 0 0 0 2 %氟哌利多。每组 30例 ,观察 4 8h内心率、血压、呼吸频率、血氧饱和度、疼痛VAS分级 ,以及恶心呕吐、皮肤瘙痒、排气时间延长、尿潴留等副作用的发生率。结果 心率、血压、呼吸频率、血氧饱和度 2组病人无显著差异 ,皮肤瘙痒、尿潴溜的发生率亦无显著差异 ;排气时间延长 (对照组 >实验组 ,P <0 0 5 ) ,吗啡用量实验组 <对照组 ;VAS评分亦无显著差异。结论 0 0 75 %罗哌卡因复合低浓度吗啡能产生良好的镇痛效果 ,并且无明显运动神经阻滞作用 ,吗啡药量减少 ,副作用减轻 ,适于动脉硬化闭塞症血管内超声消融术术后镇痛 ,并有利于此类病人的预后。

Objective To evaluated the analgesic effect of ropivacaine and morphine with PCEA at ASO after UT in order to find better methods of PCEA. Methods 60 patients (ASA Ⅰ～Ⅱ) who performed PECA after UT were divided into 2 groups randomly of 30 per each. The test group was treated with 0.075% ropivacaine, 0.0024% morphine and 0.002% droperidol. The control group was treated with 0.004% morphine and 0.002% droperidol. HR, MAP, RR, SPO 2, VAS pain scores, nausea and vomiting, pruritus, fart-time, urinary retention were observed postoperatively within 48 h. Results HR, MAP, RR, SPO 2, pruritus, urinary retention and VAS pain scores had no difference in both groups. The fart-time had difference with test group and control group (P<0.05). morphine had lower concentration in test group than that in control group. Conclusion This method could increase the analgesic effect of ASO after UT.