左旋布比卡因、盐酸罗哌卡因、氯普鲁卡因术后持续硬膜外自控镇痛效应研究  

Analgesic efficacy comparison of continuous epidural infusion of 0.125% levobupivacaine,0.125% ropivacaine and 1.8% chlorprocaine

作　　者：杨程[1] 闫诺[1] 杨宜平[1] 

机构地区：[1]武警医学院附属医院麻醉科,天津300162

出　　处：《海南医学院学报》2012年第4期548-550,553,共4页Journal of Hainan Medical University

基　　金：中国高校医学期刊临床专项资金项目(112210114)~~

摘　　要：目的:观察0.125%左旋布比卡因(LBUP)、0.125%盐酸罗哌卡因(ROP)、1.8%氯普鲁卡因(CH)用于持续硬膜外自控镇痛(PCEA)的效果。方法:75例下腹部手术ASAⅠ～Ⅱ级患者随机分为LBUP组(L组)、ROP组(R组)、CH组3组,每组25例,L组0.125%左旋布比卡因、R组0.125%罗哌卡因、CH组1.8%氯普鲁卡因,各组均加入40μg舒芬太尼,采用PCEA,设置为负荷剂量(5mL)+持续剂量(2mL/h)+PCA剂量(2mL/次),时间10min,镇痛时间48h。观察并比较3组PCEA期间4、8、12、24、48h的视觉模拟评分(VAS)、布氏(BCS)舒适评分、Ramsay镇静评分、Prince-Henry评分、Bromage评分情况。结果:3组患者术中硬膜外用药剂量、术中辅助用药剂量及手术时间差异均无统计学意义(P>0.05);3组的镇痛效果均满意,VAS、BCS、Ramsay、Prince-Henry评分差异均无统计学意义(P>0.05),L组术后4、8hBromage评分达到0级者分别为32%、44%,明显低于R(60%、60%)、CH组(52%、52%)(P<0.05～0.01),术后12h后各组差异无统计学意义(P>0.05)。结论:3组镇痛效果相似,但盐酸罗哌卡因、氯普鲁卡因运动阻滞恢复时间较快,更利于术后患者运动功能的恢复。Objective： To investigate the analgesic efficacy and safety of continuous epidural infusion of 0.125% levobupivacaine,0.125% ropivacaine and 1.8% chlorprocaine in patients undergoing lower abdominal surgery.Methods：Seventy-five ASAⅠ-Ⅱpatients undergoing lower abdominal operation under epidural anesthesia were randomly divided into three groups： group L levobupivacaine（n=25）,group R ropivacaine（n=25）,group CH chlorprocaine（n=25）,and was given PCEA as following regimen： a loading dose（5 mL） ＋ continuous dose（2 mL / h） ＋ PCA（2 mL / second） for a period of 48 h.Observed and compared visual analog scale（VAS）,Brinell（BCS） comfort score Ramsay sedation score,Prince-Henry score,Bromage score at 4 th,8 th,12 th,24 th,and 48 th h of the three groups.Results：There was no significant difference in the dosage of consumed drugs,or operation time（P0.05）.The analgesia was satisfactory in three groups,no significant difference in VAS BCS、Ramsay、Prince-Henry scores was found among the three groups.32% and 44% of patients in group L showed Bromage score of zero at 4th and 8th h of PCEA,significant lower than the 60% 60% in group R and 52% 52% in group CH（P0.05~0.01）.No significant difference in scores at 12 h was found（P0.05）.Conclusions： Epidural infusion of 0.125% levobupivacaine,0.125% ropivacaine and 1.8% chlorprocaine are satisfactory for postoperative analgesia.But recovery of motor block produced by levobupivacaine is quicker than that produced by ropivacaine and chlorprocaine,therefore it＇s better for postoperative recovery of motor function.

关 键 词：左旋布比卡因 罗哌卡因 氯普鲁卡因 硬膜外自控镇痛 

分 类 号：R614[医药卫生—麻醉学]