0.2%左旋布比卡因硬膜外持续背景输注期间不同药物对PCA效应的影响  

Comparison of different analgesic effect on PCA during 0.2% levobupivacaine epidural continuous infusion

作　　者：王淼[1] 佘守章[1] 许学兵[1] 谢晓青[1] 

机构地区：[1]广州医学院附属市一人民医院麻醉科,广州510180

出　　处：《广东医学》2006年第11期1614-1617,共4页Guangdong Medical Journal

摘　　要：目的 比较硬膜外持续背景输注0．2％左旋布比卡因期间布托啡诺、氯诺昔康和吗啡患者静脉自控镇痛（PCIA）的临床效应和不良反应。方法 选择择期经腹子宫全切手术患者60例（ASAⅠ～Ⅱ级），随机分为3组：布托啡诺组（B组）、氯诺昔康组（L组）和吗啡组（M组）。采用双泵法行双盲对照观察，第一泵：3组均为硬膜外持续输注0．2％左旋布比卡因4ml／h；第二泵：B组以布托啡诺PCIA强化，L组以氯诺昔康PCIA强化，M组以吗啡PCIA强化。镇痛效应对术后1，2，4，8，12，16，20及24h采用视觉模拟评分（VAS）、Ramesay镇静评分、术后运动神经阻滞恢复评分（改良Bromage分级）和患者对PCA综合满意度评分，记录术后0～1h，～2h，～4h，～8h，～12h，～16h，～20h，～24hPCA泵的按压次数（D1）与实际进入次数（D2），并记录肛门排气时间及可能出现的不良反应。结果 3组患者的一般情况相似，24h硬膜外左旋布比卡因的使用剂量为192mg，3组患者未按压PCA泵的患者各为1例（5％），静脉用药量分别为（0．82±0．55）mg（B组），（11．40±2．80）mg（L组），（4．70±3．50）mg（M组），在相同时间段内3组间VAS、Ramesay镇静评分、Bromage分级及D1／D2值均相似。结论 在0．2％左旋布比卡因硬膜外持续输注（4ml／h）的基础上，新型阿片受体激动拮抗药布托啡诺与氯诺昔康和吗啡静脉PCA均能达到辅助镇痛的效果，静脉PCA布托啡诺与吗啡的镇痛效应比例约为1：5。Objective To compare the analgesic and adverrse effects of patient - controlled intravenous analgesia（PCIA） with butorphanol, lomoxicam and morphine supplemented by continuous epidural infusion of 0.2% levobupivacaine. Methods Sixty ASA Ⅰ～Ⅱ patients undergoing elective abdominal hysterectomy under epidural anesthesia were randomly divided into three groups： butorphanol group （ n = 20） ,lomoxicam group（ n = 20） and morphine group （ n = 20）. Two Graseby pumps were used for each patient. Pump A was for continuous epidural infusion of 0.2% levobupivacaine at a rate of 4 ml/h among three groups. In butorphanol group, pump B was for patient - controlled intravenous analgesia（PCIA） of butorphanol. In lomoxicam group, pump B was for patient - controlled intravenous analgesia（PCIA） of lomoxicam. In morphine group, pump B was for patient - controlled intravenous analgesia（PCIA） of morphine, the analgesic effects were assessed by VAS score of pain, Ramesay sedation score, modified Bromage score, patients satisfaction for PCA and the number of pressing of PCIA pump by the patient （ D1 ） at 1 h,2 h,4 h,8 h, 12 h, 16 h,20 h,24 h and the number of bolus dose delivered（De） ,the time when the patient passed gas and possible complications. Results The general state of health was similar among three groups. The amount of levobupivacaine consumed was 192 mg in three groups. The amount of butorphanol consumed was （0.82 ± 0.55）mg in butorphanol group, The amount of lomoxicam consumed was （ 11.40 ± 2.80 ）mg in lomoxicam group and the amount of morphine consumed was （4.70 ± 3.50）mg in morphine group. There was no statistically significant difference in VAS, Ramesay sedation score, modified Bromage score and D1/D2 during the same duration among three groups. Conclusion New type opioid receptor agonist - antagonist anesthetics butorphanol can achive the same auxiliary analgesic effect as lomoxicam and morphine on the base of the continuous epidural infusion of 0.2% levobupivacaine

关 键 词：镇痛 病人控制 布托啡诺 氯诺昔康 吗啡 

分 类 号：R614.42[医药卫生—麻醉学]