芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的比较  

A Comparison between Epidural Morphine and Fentanyl Combined with Ropivacaine for Postoperative Analgesia

作　　者：白晓晖[1,2] 董静毅[3] 温丽丽[4] 林文前[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室 [2]中山大学肿瘤防治中心麻醉科,510060 [3]广州市番禺区人民医院麻醉科 [4]广东省中医院麻醉科

出　　处：《岭南急诊医学杂志》2008年第5期348-349,352,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:比较芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的效果及不良反应的发生率。方法:择期肿瘤手术患者150例随机分为Ⅰ组、Ⅱ组、Ⅲ组各50例。Ⅰ组给予吗啡60～80μg/mL复合0.125%罗哌卡因100mL硬外镇痛;Ⅱ组给予芬太尼5～6μg/mL复合0.125%罗哌卡因100mL硬外镇痛;Ⅲ组单纯给予芬太尼20μg/kg静脉镇痛。比较三组术后不同时点VAS评分、Ramsay评分以及不良反应的发生率。结果:VAS评分三组间比较差异无统计学意义(P>0.05);Ⅲ组在术后12h、24h、48h的Ramsay评分显著高于其他组(P<0.05);恶心、呕吐、皮肤瘙痒的发生率Ⅱ组、Ⅲ组均显著小于Ⅰ组(P<0.05);头晕、嗜睡的发生率Ⅰ、Ⅱ组显著低于Ⅲ组(P<0.05)。结论:芬太尼联合低浓度罗哌卡因用于术后硬膜外镇痛效果确切、不良反应发生率少。Objective： To compare the analgesic efficacy and side effects of epidural fentanyl or morphine combined with 0.125% ropivacaine. Methods：150 cancer patients scheduled for different elective surgery were randomly divided into 3 groups. In group Ⅰ , patients received 0.125% ropivacaine combined with 60-80μg/mL of morphine for postoperative analgesia. In group Ⅱ ,patients received 0.125% ropivacaine combined with 5-6 μg/mL fentanyl for postoperative analgesia .In group Ⅲ , patients received a intravenous infusion of 20 μg/mg fentanyl at a rate of 2 mL/h for postoperative analgesia. Quality of analgesia and degree of sedation was assessed by VAS and Ramsay scores at 4h （T1）, 12b （T2）, 24h （T3） and 48h （T4） after surgery. Episodes of side effects were recorded. Results：The VAS pain scores have no significant difference between groups; Ramsay sedation scores of group Ⅲ were higher at 12 h, 24 h and 48 h after surgery compared with group Ⅰ and Ⅱ ; the incidences of nausea, vomiting, and pruritus were significant higher in group I and the incidences of dizziness, lethargy were significant higher in group Ⅲ compared with other groups, Conclusions：Epidural fentanyl combined with low concentration ropivacaine is feasible for postoperative analgesia, owing to effective analgesia and lower incidence of side effects.

关 键 词：芬太尼 吗啡 罗哌卡因 硬膜外镇痛 不良反应 

分 类 号：R614[医药卫生—麻醉学]