摘要
目的 观察不同浓度、不同速率罗比卡因在开胸术后硬膜外腔的镇痛效果及不良反应。方法 6 0例开胸手术后病人随机均分为四组 :Ⅰ组 ,0 0 5 %罗比卡因 +芬太尼 1μg/ml,8ml/h ;Ⅱ组 ,0 1%罗比卡因 +芬太尼 2 μg/ml,4ml/h ;Ⅲ组 ,0 2 %罗比卡因 +芬太尼 4 μg/ml,2ml/h ;Ⅳ组 ,0 1%布比卡因 +芬太尼 2 μg/ml,4ml/h。各组病人硬膜外自控镇痛 (PCEA)每次 2ml,锁定时间15min。各组负荷量为芬太尼 5 0 μg +0 75 %罗比卡因或布比卡因 (2ml) +生理盐水至 4ml。观察病人静息和咳嗽疼痛评分及不良反应。结果 镇痛效果及术后 4 8h疼痛评分 ,Ⅰ、Ⅱ、Ⅳ组之间无明显差异 (P >0 0 5 ) ,但明显优于Ⅲ组 (P <0 0 5 ) ,且 4 8hPCEA消耗量、总按压次数与有效按压次数之比 (TPCA/EPCA)Ⅲ组明显高于Ⅰ、Ⅱ、Ⅳ组 (P <0 0 5 )。Ⅲ组术后当日还需辅助使用其他镇痛药(5 / 15 )。瘙痒、恶心、呕吐、镇静程度各组之间差异无显著性。均未观察到呼吸抑制或下肢运动神经阻滞。Ⅳ组出现血压下降 6例 (4 0 % ) ,自觉咳嗽无力 3例 (2 0 % ) ,Ⅲ组自觉咳嗽无力 2例 (13 33% )。结论 0 0 5 %罗比卡因 +芬太尼 1μg/ml、背景 8ml/h或 0 1%罗比卡因 +芬太尼 2 μg/ml、背景 4ml/h对开胸手术后病人不仅有良好的镇痛效果 ,
Objective To investigate the effects of analgesia and occurrence of side events of PCEA with different concentration and volume of ropivacaine after thoracotomy.Methods 60 ASA physical status Ⅰ-Ⅱ patients undergoing selective thoracic surgery received propofol general/epidural anesthesia. After surgery,patients were randomly divided into 4 groups with 15 cases each. 0.05% ropivacaine and fentanyl 1 μg/ml ,8 ml/h were given in groupⅠ, 0.1% ropivacaine and fentanyl 2 μg/ml,4 ml/h in groupⅡ,0.2% ropivacaine and fentanyl 4 μg/ml ,2 ml/h in group Ⅲ and 0.1% bupivacaine and fentanyl 2 μg/ml ,4 ml/h in Group Ⅳ. Dynamic visual analogue pain scale (VAS)during rest or coughing ,pulse oxymetry(SpO 2),hemodynamic variables were evaluated every 4 hours. Occurrence of side events,respiratory complications were also recorded within two postoperative days. Results There was no difference (P>0.05) in VAS among groupⅠ,Ⅱ and Ⅳ,which was less than that in group Ⅲ (P<0.05). The dose of PCA in group Ⅲ was more than that in group Ⅰ,Ⅱ or Ⅳ.5 cases needed any additional anaesthetics during the first 24 postoperative hours in groupⅢ . There were no cases with respiratory depression or motor blockade of the lower extremity ,but 6 cases with hypotension,3with weakness during coughing in group Ⅳ,and 2 with weakness during coughing in groupⅢ. Conclusion Either 0.05% ropivacaine with fentanyl 1 μg/ml ,8 ml/h or 0.1% ropivacaine with fentanyl 2 μg/ml ,4 ml/h can provide satisfactory postoperative PCEA without significant side effects in thoracic surgical patients.
出处
《临床麻醉学杂志》
CAS
CSCD
2004年第9期526-528,共3页
Journal of Clinical Anesthesiology
