硬膜外腔注入0．2％罗哌卡因对全麻下阑尾炎手术患者痛觉过敏的影响  

Effects of Epidural Cavity Injection of 0.2 % Ropivacaine on Hyperalgesia In Patients Undergoing Appendicitis Surgery Under General Anesthesia

作　　者：朱俊峰[1] 杨璐[2] 

机构地区：[1]北京市石景山医院麻醉科,北京100043 [2]北京大学第三医院麻醉科,北京100083

出　　处：《医学临床研究》2015年第7期1336-1338,1341,共4页Journal of Clinical Research

摘　　要：【目的】探讨硬膜外腔注入0．2％罗哌卡因对全麻下阑尾炎手术患者痛觉过敏的影响。【方法】选择2010年5月至2014年2月本院收治的100例全麻下行阑尾炎手术患者，美国麻醉师协会（ASA）分级为Ⅰ～Ⅱ级，将患者随机分为罗哌卡因组和芬太尼组，每组各50例。罗哌卡因组：手术前先经硬膜外导管注射0．2％罗哌卡因10mL，术中每隔1h追加一次罗哌卡因5mL，于手术结束前再注射0．2％罗哌卡因10mL；芬太尼组：手术前后分别经静脉注射芬太尼2μg／kg。观察两组患者入室时（T0）、诱导时（T1）、切皮时（T2）、术中探查时（T3）、关腹时（T4）及术毕时（T5）的SBP、DBP以及HR变化，记录拔管后1h（T6）、4h（T7）、12h（T8）、24h（T8）的视觉模拟评分法（VAS）评分。记录比较患者术后12h和24h的触痛阂和机械痛觉过敏范围。【结果】罗哌卡因组患者的T2、T3时间点SBP、DBP低于芬太尼组患者，差异具有统计学意义（P〈0．05）；罗哌卡因组患者的T6、T7、T8、T9时点VAS评分均低于芬太尼组患者，差异具有统计学意义（P〈0．05）；罗哌卡因组患者三个测定点的触痛闽均高于芬太尼组患者，三条测定线上的机械痛觉过敏范围均较芬太尼组窄，差异具有统计学意义（P〈0．05）；术后12h与24h两组患者三个测定点的触痛阂均较术前低，差异有统计学意义（P〈0．05）。【结论】经硬膜外腔注入低浓度0.2％罗哌卡因能够减少全麻下阑尾炎手术中的阿片类镇痛药物的用量，并且能够减轻患者术后痛觉过敏的范围和程度。[Objective] To explore the effects of epidural cavity injection of 0.2% ropivacaine on hyperalgesia in patients undergoing appendicitis surgery under general anesthesia. [Methods] A total of 100 patients （American Society of Anesthesiologists class I-II ） undergoing appendicitis surgery under general anesthesia from May 2010 to February 2014 were selected and randomly divided into two groups of ropivacaine （L） and fentanyl （F）. Group L： epidural catheter injection of 0.2% ropivacaine 10 ml before surgery, intraoperative 5 ml every 1 h to append ropivacaine inject and finally 10 mL before the end of surgery; group F： intravenous fentanyl 2 μg/kg before and after operation. The timepoints were entry into operating room （T0）, induction （T1）, skin incision （T2）, intraoperative exploration （T3）, closure （T4） and completion （T5）. The values of systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were recorded. And the visual analogue scale （VAS） scores were measured at 1 h post-extubation （T6）, 4 h （T7）, 12 h（T8） and 24 h （T9）. At 12 h and 24 h postoperation, tenderness threshold and mechanical hyperalgesia were evaluated. [Results] In group L at T6, T7, T8 and T9, VAS scores were lower than those of group F. And the differences were statistically significant （ P〈0.05） ; L group at T6, T7 , T8, T9 , VAN scores were lower than those of group F. And the differences were statistically significant （ P〈0.05） ; L group at 3 measuring points of bitterness threshold was higher than those of group F, 3 measurement ranges of mechanical hyperalgesia were narrow in group F. And the differences were statistically significant （ P d0. 05）; Compared with before operation, two groups with 3 measuring points of tenderness threshold decreased after 12 h and 24 h . And the differences were statistically significant （P〈0.05）. [Conclusion] An epidural injection of 0.2% ropivacaine may reduce opioid dosage during append

关 键 词：阑尾炎/外科学 麻醉 全身 痛觉过敏 酰胺类/投药和剂量 注射 硬膜外 

分 类 号：R574.61[医药卫生—消化系统]