罗哌卡因与布比卡因复合芬太尼用于开胸术后PCEA的对比观察  

Comparison of effect of ropivacaine-fentanyl with bupivacaine-fentanyl on PCEA after thoracotomy

作　　者：于雪梅[1] 关红漫[1] 年爱时[1] 

机构地区：[1]大连医科大学附属第一医院麻醉科,辽宁大连116011

出　　处：《中国现代医学杂志》2004年第16期133-134,136,共3页China Journal of Modern Medicine

摘　　要：目的该文比较低浓度罗哌卡因与布比卡因用于PCEA对开胸手术病人的镇痛效果、副作用等方面的异同。方法40例ASAⅠ,Ⅱ级开胸手术病人,采用全麻复合硬膜外麻醉。随机分为2组,每组20例。Ⅰ组(0.2%罗哌卡因200ml内含芬太尼2μg/ml、枢丹8mg),Ⅱ组(0.15%布比卡因200ml内含芬太尼2μg/ml、枢丹8mg)。术后病人清醒拔管,行PCEA,持续注入速度5ml/h,病人自控剂量1ml/h,间隔时间15min。观察(1)镇痛效果:术后1,2,3d病人静止(R-VAS)和咳嗽(C-VAS)疼痛评分(2)副作用:观察病人是否有皮肤瘙痒、恶心、呕吐、尿潴留、血压下降、呼吸抑制。结果两组病人术后VAS评分差异无显著性。各组中瘙痒、恶心、呕吐、镇静及血压下降的发生率无显著性差异,均未观察到呼吸抑制、运动阻滞和尿潴留的发生。结论低浓度罗哌卡因和布比卡因复合芬太尼用于开胸手术PCEA可良好镇痛,无明显循环呼吸抑制,不良反应小。Objective: Patient-controlled epidural analgesia (PCEA) after tnoracotomy had been believed to be safe and satisfactory. Ropivacaine was a new long-acting amide type local anesthetic. The purpose of this study was to compare the effect of ropivacaine-fentanyl with bupivacaine-fentanyl on PCEA after tnoracotomy. Methods: Forty ASA Ⅰ,Ⅱ patients undergoing elective tnoracotomy under general aneathesia and epidural block were randomly divided into two groups: Ⅰ(20 patients, 0.2% ropivacaine 200 ml including fentanyl 2 ug/ml and ondansetron 8 mg) and Ⅱ(20 patients, 0.15% bupivacaine 200 ml including fentanyl 2 ug/ml and ondansetron 8 mg). After postoperative awake extubation PCEA was performed. The backgroud infusion rate was 5 ml/h, bolus dose was 1 ml/h and lockout interval was 15 min. The patients were assessed for 3 days after operation for pain (R-VAS and C-VAS) and adverse effects (itching, nausea and vomiting, urinary retention, decreased blood pressure and respiratory depression). Results: Postoperative analgesia was satisfactory in all groups. There was no significant difference in the percentage of patients with VAS and adverse effects among the two groups. No significant respiratory depression and motor blockade were recorded. Conclusions: The effect of combined low concentration ropivacainr or bupivacaine with fentanyl on PCEA after tnoracotomy is satisfactory, with little harmful effects (for instance respiratory depression).

关 键 词：镇痛 硬膜外 罗哌卡因 布比卡因 芬太尼 

分 类 号：R614.27[医药卫生—麻醉学]