高龄患者下腹部手术硬膜外不同浓度左旋布比卡因结合芬太尼术后镇痛效果评价  

Effectiveness evaluation of epidural anesthesia during lower abdominal operation and postoperative combined administration of fentanyl and levobupivacaine epidural analgesia in the advanced elderly patients

作　　者：戴晓凤[1] 李海芳[2] 陆惠元[1] 张延平[1] 王丽[1] 

机构地区：[1]青岛大学医学院第二附属医院,山东青岛266042 [2]青岛市第三人民医院,山东青岛266041

出　　处：《黔南民族医专学报》2015年第4期247-250,260,共5页Journal of Qiannan Medical College for Nationalities

摘　　要：目的：评价高龄患者下腹部手术硬膜外麻醉效果和术后硬膜外不同浓度左旋布比卡因结合芬太尼患者自控镇痛效果、舒适度、满意度及副作用。方法：40例高龄下腹部手术患者，年龄80～93岁，体重49—81kg，ASAⅡ、Ⅲ级。L2—3硬膜外穿刺注入0．5％左旋布比卡因3ml，头端置管5cm，注入0．375％左旋布比卡因初量和追加量维持阻滞平面。手术结束随机均分为A组（0．1％左旋布比卡因＋2μg／ml芬太尼）、B组（0．05％左旋布比卡因＋2μg／ml芬太尼）各20例，接硬膜外自控镇痛泵输入镇痛药液治疗48h，观察记录术中术后感觉和运动阻滞，血液动力学和SpO2变化，术后安静和活动时镇痛评分（VAS score）、Ramsay镇静评分、舒适度和患者满意度评分以及副作用。结果：两组患者一般情况比较无显著差异（P〉0．05），术中肌松满意。术后6hBP、HR显著下降（P〈0．05），吸氧和麻醉后SpO2显著升高（P〈0．01）。术后48h内VAS评分A、B组安静时比较无显著差异（P〉0．05），活动时比较VAS评分差异显著（P〈0．05），Ramsay镇静评分A、B组比较无显著差异（P〉0．05），A组舒适度评分（P〈0．05），患者满意度评分优于B组（P〈0．01），B组2例有轻微恶心外无其他明显副作用发生。结论：高龄患者下腹部手术硬膜外置管前注入0．5％左旋布比卡因3ml再经导管注入局麻液可收到满意的麻醉效果，术后硬膜外镇痛泵输注0．1％左旋布比卡因复合2μg/ml芬太尼比0．05％左旋布比卡因复合2μg／ml芬太尼有较好镇痛作用、舒适度和患者满意度并且无明显副作用。Objective： To evaluate the effects of epidural anesthesia and postoperative 0. 1% or 0. 05% levobupivacaine plus fentanyl administration in elderly patients during lower abdominal operation, including the patientcontrolled epidural analgesia （PCEA）, bruggrmann comfort scale （BCS）, patients satisfaction scores （PSS） effect and side effect in the advanced age patients. Methods： A total of 40 ASA Ⅱ - Ⅲ patients, aged （80 -93） yr, weight （49 -81 ） kg, ready for lower abdominal surgery, were enrolled for the study. Lumber puncture was performed at the L2 -3 interspace, 0. 5% levobupivacaine 3ml as a ＂ test dose ＂ was injected prior to epidural insertion and then epidural insertion upward 5cm. The patients would receive sequential 0. 375% levobupivacaine initial volume and the anesthesia was maintained with incremental volume if necessary. At end of operation the patients were randomly divided into group A （0. 1% levobupivacaine ＋ 2μg/ml fentanyl） and group B （0. 05% levobupivacaine ＋2μg/ml fentanyl） of 20 patients each, and then continuous epidural analgesia pump input analgesia 48hr. The spread level of analgesia, Bromagc scale, BP, HR, ECG and SpO2, Visual analog scale, Ramsay sedation scale, BCS and PSS ware continuously monitored during and post surgery. Adverse events were observed and compared. Results： Two groups were demographically same and had similar hemodynamics except postoperative 6hr BP HR decreased （P 〉 0. 05）. The patients had satisfactory muscle relaxation. After operation, BP and HR were significantly decreased （ P 〈 0. 05 ）. After inhaling oxygen and injecting local anesthetic, initial volume SpO2 of two groups were significantly increased （P 〈0. 01 ）. When the patients were quiet in group A, B or activities in group A, VAS score in 48h showed no significant difference （ P 〉 0. 05）, VAS score of activities in group B was found significant difference compared with group A （ P 〈 0. 01 ）. Ramsay sedation score of group A, B

关 键 词：左旋布比卡因 硬膜外麻醉 下腹部手术 患者自控硬膜外镇痛 高龄 

分 类 号：R614[医药卫生—麻醉学]