开胸术后罗哌卡因复合舒芬太尼硬膜外自控镇痛对肺功能的影响  

Pulmonary function during patient-controlled thoracic epidural analgesia with ropivacaine and sufentanil for postoperative pain

作　　者：黄勇[1] 刘鲲鹏[1] 王艳[1] 韩柳[1] 张金华[1] 贾乃光[1] 

机构地区：[1]北京市卫生部中日友好医院麻醉科,100029

出　　处：《实用疼痛学杂志》2010年第3期178-182,共5页Pain Clinic Journal

摘　　要：目的比较开胸术后罗哌卡因、舒芬太尼硬膜外镇痛和吗啡静脉镇痛对肺功能的影响。方法择期行肺叶切除术患者40例，随机分为两组：罗哌卡因组采用0．2％罗哌卡因复合0．4μg／ml舒芬太尼胸部硬膜外连续输注；吗啡组采用吗啡经静脉自控镇痛。测量术后24、48h肺功能（用力肺活量FVC、1秒用力呼出量FEV1、呼气峰流速PEF）和血气分析，记录副作用和肺部并发症。结果术后24、48h罗哌卡因组患者的肺功能显著优于吗啡组（P〈O．05），氧分压显著高于吗啡组（P〈0．01）。吗啡组患者术后恶心发生率显著高于罗哌卡因组（P〈0．05），其他副作用无统计学差异，两组患者均未见肺部合并症。结论与吗啡静脉自控镇痛相比较，0．2％罗哌卡因复合舒芬太尼0．4μg／ml硬膜外自控镇痛可明显改善肺功能。Objective To assess the effects of patient-controlled thoracic epidural analgesia with ropivacaine and sufentanil on pulmonary function for postthoracotomy pain. Methods Forty patients undergoing selective pneumonectomy were randomly divided into two groups. Patients in group R（n=20） were received patient-controlled thoracic epidural analgesia with 0.2% ropivacaine and 0.4μg/ml sufentanil at 4 mt/h,and patients in group M（n=20） with patient-controlled intrave- nous morphine analgesia. Pulmonary function and arterial blood gas analysis were measured at 24 h and 48 h postoperatively. The incidences of side-effects and pulmonary complications were also recorded. Results Pulmonary function in group R was significantly better preserved than that in group M at 24, 48 h postoperatively （P〈0. 05）. PaO2 in group R was higher than that in group M at 24, 48 h post operatively（P〈0.01）. The incidence of postoperative nausea was significantly increased in group M （P〈0.05）. No pulmonary complications occurred in both groups. Conclusions Epidural patient- controlled analgesia with ropivacaine and sufentanil provides more effective improvement of pulmonary function than that with patient-controlled intravenous morphine analgesia.

关 键 词：罗哌卡因 舒芬太尼 镇痛 硬膜外 肺功能试验 胸外科手术 

分 类 号：R614.42[医药卫生—麻醉学]