氯普鲁卡因与舒芬太尼用于术后病人硬膜外镇痛的临床研究  

Clinical study of patient controlled epidural analgesia using Chloroprocaine hydrochloride combined with Sufentanil in patients with lower limbs surgery

作　　者：彭志勇 程智刚[2] 白念岳[2] 王云姣[2] 杨胜辉[2] 彭为平 郭曲练[2] 

机构地区：[1]南海人民医院麻醉科,广东佛山528200 [2]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2011年第15期1881-1884,共4页China Journal of Modern Medicine

摘　　要：目的研究盐酸氯普鲁卡因(chloroprocaine hydrochloride,CP)复合舒芬太尼合用于骨科下肢手术术后硬膜外镇痛的效果。方法 120例ASAⅠ～Ⅱ级择期骨科下肢手术后患者,随机分为5组。CP浓度为0.6%(A组)、0.8%(B组)、1.0%(C组)、1.2%(D组)、1.4%(E组),各组舒芬太尼浓度均为0.4μg/mL,术后以2mL/h速度持续泵注行硬膜外镇痛。分别于术毕、术后30 min、1 h、2 h、4 h、8 h、24 h、48 h观察病人的视觉模拟评分、改良Bromage评分、感觉阻滞平面、无创血压、心率、呼吸及副作用(恶心、呕吐等)。结果 A组和B组术后1hVAS评分明显高于C组、D组和E组(P<0.05),其中有9例接受1次、4例接受2次硬膜外注射吗啡治疗后疼痛缓解。C组、D组和E组均有良好镇痛效果,各组间VAS评分无差异(P>0.05)。各组间的Bromage评分无明显差异(P>0.05)。术毕1 h后C组感觉神经阻滞平面与D组、E组感觉神经阻滞平面低一个节段,2 h后C组感觉神经阻滞平面与D组、E组间感觉神经阻滞平面差异明显(P<0.05)。各组间心率、血压比较无统计学差异。结论 1.0%氯普鲁卡因伍用0.4μg/mL舒芬太尼用于术后硬膜外镇痛能产生良好镇痛,无不良反应,是骨科下肢手术适宜的镇痛方法。【Objective】 To study the analgesic and side effects of Chlorpromazine Hydrochlo-ride（CP） combined with Sufentanil for patient controlled epidural analgesia（PCEA） in patients with lower limbs surgery.【Methods】 One hundred and twenty patients（ASA Ⅰ～Ⅱ） with elective orthopedic lower limb surgery were divided randomly into five groups with 24 patients each.CP concentration of 0.6%（group A）,0.8%（group B）,1.0%（group C）,1.2%（group D）,1.4%（group E）,Sufentanil concentration was 0.4 μg/mL in each group.All patients were received CP combined with Sufentanil for continuous epidural anesthesia.The analgesia effects was evaluated by visual analogue scales（VAS）,Bromage scores and side effects such as nausea and vomiting,were also recorded at 30 min,1,2,4,8,24 and 48 hours after operation.【Results】 VAS scores in group A and B were higher significantly than those in group C,D and E.There were nine cases accepted once,four cases accepted two times epidural morphine in group A and B,which showed pain relief obviously after treatment.There were good analgesia and no significant differences in the potency of analgesia and VAS scores in Group C,D and E（P 0.05）.There were no significant differences in Bromage scores in Group C,D and E（P 0.05）.Sensory block levels in Group C recovered to a lower section than that in Group D and E at 1 hour after operation.There were differences significantly in sensory block levels among C,D and E group at 2 hours after operation（P 0.05）.【Conclusions】 PCEA with 1.0% Chlorpromazine combined with 0.4 μg/mL Sufentanil was the most safe and effective for patient after lower limbs surgery.

关 键 词：盐酸氯普鲁卡因 舒芬太尼 镇痛 硬膜外 

分 类 号：R614.42[医药卫生—麻醉学]