左旋布比卡因在乳腺癌术后病人自控硬膜外镇痛中的应用  

Application of Levobupivacaine in Epidural Analgesia for Patients After Radical Mastectomy

作　　者：杨建兵[1] 刘建平[1] 

机构地区：[1]湖南省长沙市妇幼保健院麻醉科,湖南长沙410007

出　　处：《医学临床研究》2006年第4期536-538,共3页Journal of Clinical Research

摘　　要：【目的】比较0．15％、0．20％和0．25％的左旋布比卡因加2μg／ml芬太尼用于乳癌术后病人自控硬膜外镇痛（PCEA）的效果及对通气功能的影响。【方法】90例ASAⅠ～Ⅱ级择期乳癌根治术的病人、随机分为三组，T3-4或T4-5常规硬膜外穿刺向头端置管，先注入1％利多卡因3ml为试验量，5min后分别以0．15％（A组）、0．20％（B组）和0．25％（C组）的左旋布比卡因加2／μg／ml芬太尼维持麻醉并继续行术后PCEA，持续镇痛治疗48h，由不知情者记录术后O～6h，6～24h，24～48h各时段休息和咳嗽时的VAS评分，呼吸频率、潮气量和分钟通气量以及不良反应。【结果】三组病人均未出现严重的并发症。B组与C组之间VAS评分比较差异无显著性（2．8±2．2vs2．7±2．1，P〉0．05），A组与B组之间VAS评分比较术后24h内均有有显著性差异（3．2±2．5vs2．8±2．1，P〈0．05），呼吸频率、潮气量和分钟通气量三组各时点比较差异无显著性（P〉0．05）。【结论】0．20％和0．25％的左旋布比卡因加2μg／ml芬太尼可满意而安全地用于乳腺癌根治手术后PCEA。[Objective]To compare the effects on respiratory function of 0. 15% 、0. 20% and 0. 25% levobupivacaine with 2 μg/ml fentanyl for patient controlled upper thoracic epidural analgesia（PCEA） after selective radical mastectomy. [Methods]Ninty ASA Ⅰ-Ⅱ patients were anesthetized with upper thoracic epidural block. T3-4 or T4-5 were selected as puncture site. A catheter was inserted into the epidural space in a cephalad direction for 3-4 cm. A loading dose of 0. 15%（group A, n =30）,0.20% （group B, n =30） and 0. 25%（group C n=30） levobupivacaine with 2 μg/ml fentanyl was given after a test dose of 1% lidocaine 3 ml and continuously used levobupivacaine for PCEA 48 hours after operation. Dynamic visual analogue pain scale （VAS） during rest or coughing, side-effects, meanwhile the breathing frequency, minute ventilation, and tidal volume were monitored within two postoperative days. [Results]There were no side-effects were recorded in all patients. VAS was not significantly different between group B and group C （ P 〉0.05） ,but higher in group A （ P 〈0.05） on the first day after surgery. [Conclusion]Either 0. 20% or 0.25% levobupivacaine with 2 μg/ml fentanyl can provide satisfactory postoperative PCEA for patients undergoing selective radical mastectomy.

关 键 词：乳腺肿瘤/外科学 布比卡因/投药和剂量 镇痛 病人控制 镇痛 硬膜外 

分 类 号：R737.9[医药卫生—肿瘤]