左布匹卡因与罗比卡因用于手术后患者硬膜外自控镇痛的观察  

A Comparison Patient-controlled Epidural Analgesia (PCEA) with 0.15% Levobupivacaine versus 0.2% Ropivacaine in Patients after Abdominal Operations

作　　者：马浩南[1] 孙德宪 王庚寅[1] 吴震华[1] 赵晓民[1] 崔斌斌[1] 刘彦[1] 

机构地区：[1]天津市第一中心医院,天津泰达中心医院300011 [2]天津泰达中心医院

出　　处：《天津医药》2006年第7期470-472,共3页Tianjin Medical Journal

摘　　要：目的:观察左布匹卡因与罗比卡因用于腹部手术后自控硬膜外镇痛(PCEA)的效果及不良反应。方法:60例ASAⅠ～Ⅱ级腹部手术患者,随机分为0.15%左布匹卡因加2mg/L芬太尼组(A组)30例与0.2%罗比卡因加2mg/L芬太尼组(B组)30例,以5mL/h行术后硬膜外泵注镇痛。记录术后4、8、24、48h的疼痛视觉模拟评分(VAS0～10分)、满意度评分、运动阻滞测试(改良Bromage评分)及术后活动能力4级评分;48h内按压PCA次数(PCAd)、PCA有效次数(PCAe)、D/D比值(PCAd/PCAe)及不良反应。结果:2组镇痛效果满意,2组各观察指标差别均无统计学意义(P>0.05)。在术后第1天,A组有14例(46.7%)可以短时间行走,而B组有25例(83.3%)。第2天,A组有15例(50.0%)可以自由行走,而B组有26例(86.7%),2组差别有统计学意义(P<0.05)。不良反应:恶心发生率A组13.3%(4/30),B组10.0%(3/30),皮肤瘙痒发生率2组均为6.7%(2/30),差异无统计学意义(P>0.05)。结论:0.15%左布匹卡因与0.2%罗比卡因用于患者术后硬膜外镇痛均可获得满意的效果,而0.2%罗比卡因较0.15%左布匹卡因术后活动能力恢复早。Objective： To evaluate effects and complications of the postoperative patient-controlled epidural analgesia （PCEA） with levobupivacaine and ropivacaine after abdominal operations. Methods： Sixty cases ASA physical status Ⅰ -Ⅱ abdominal operation patients were randomly allocated in a double-blind fashion into two groups： PCEA with both 0.15% levobupivacaine and 2 mg/L fentanyl （group A, n=30） was established ,on the other hand,0.2% ropivacaine and 2mg/L fentanyl （group B, n=30）established too then PCEA was performed with velocity of 5 ml./h. Dynamic visual analogue pain scale （VAS 0-10 score）, satisfaction of patients to pain relief, the motor block test （Bromage scale） and postoperative motor ability（four stages） were evaluated 4 h, 8 h, 24 h, 48 h postoperatively; as well as the number of PCA demand （PCAd） and PCA effect number （PCAe）, PCAd / PCAe ratio （D/D）and reverse effects. Results： The analgesia was satisfactory in two groups and the figure difference in two groups was not statistical （P〉0.05）. On the first postoperative day, the group B had a higher percent of patients（25cases,83.3%） who were ambulatory for a little time than the group A （14 cases,46.7%）. On the second postoperative day, 86.7% patients （26 cases） in group B can ambulate everywhere whereas 50.0% patients （15 cases）in group A can do and the difference was statistical （P〈0.05）.The rate of nausea in group A （4/30） was 13.3% versus 10.0% that was in group B（3/30） and the rate of pruritus in two groups was all 6.7%（2/30）,the difference was not statistical （P〉0.05）. Conclusion： PCEA with 0.15% levobupivacaine and 0.2% ropivacaine after abdominal operations can provide effective analgesia. Postoperative recovery in 0.2% ropivacaine was earlier than that in 0.15% levobupivacaine.

关 键 词：布比卡因 麻醉药 局部 麻醉 硬膜外 

分 类 号：R614.42[医药卫生—麻醉学] R454.1[医药卫生—外科学]