腰硬联合麻醉子宫切除术与左旋布比卡因硬膜外术术后镇痛效果的评价  

作　　者：王丰顺 陆惠元[2] 宋观忠 

机构地区：[1]青岛市龙田金秋妇产医院麻醉科,山东266071 [2]青岛大学医学院第二附属医院(青岛中心医院)麻醉科,266042

出　　处：《当代医学》2016年第35期12-15,共4页Contemporary Medicine

摘　　要：目的评价腰硬联合麻醉子宫切除术和术后患者自控左旋布比卡因药液硬膜外镇痛效果和不良反应。方法将90例子宫切除术患者随机分成A、B、C 3组,各30例。选L2-3硬膜外穿刺成功后,3组用腰穿针注入蛛网膜下腔布比卡因15 mg,然后各向头端置入硬膜外导管5 cm,术中硬膜外酌情注入追加量,维持阻滞平面T8以上。术后分别硬膜外注入A组（0.15%左旋布比卡因）、B组（0.125%左旋布比卡因＋2μg/m L芬太尼）C组（0.075%左旋布比卡因＋2μg/m L芬太尼）接硬膜外连续镇痛泵输入镇痛药液。观察记录术中局麻药用量,感觉和或术后运动阻滞,血液动力学和Sp O2变化。术后安静和活动时镇痛评分（VAS score）,Ramsay镇静评分,舒适度评分和患者满意度评分以及不良反应。结果 3组患者一般情况,局麻药用量和Sp O2感觉、运动阻滞比较差异无统计学意义,注入腰麻量5-10 min和术后6 h（P〈0.01）以及24 h（P〈0.05）BP和HR有下降。术后48 h内VAS评分3组安静时比较差异无统计学意义,24 h或48 h活动时单位小时内：组内比较或组间B组与A组或C组相比差异具有显著的统计学意义（P〈0.01）或具有统计学意义（P〈0.05）,A组Ramsay镇静评分差于B组和C组（P〈0.01）。B组舒适度评分（P〈0.05）或患者满意度评分（P〈0.01）优于A组和C组并且B组比A、C组较少不良反应发生。结论腰硬联合麻醉子宫切除术后硬膜外镇痛泵输注0.125%左旋布比卡因复合2μg/m L芬太尼比0.075%左旋布比卡因复合2μg/m L芬太尼和单用0.15%左旋布比卡因有良好的镇痛和镇静作用和较少的不良反应发生。Objective Evaluation effect of combined spinal epidural anesthesia （CSEA） in hysterectomy and patient-controlled epidural analgesia （PCEA） with levobupivacaine. Methods Ninety patients undergoing hysterectomy were randomly divided into A（n=30）, B（n=30）and C（n=30） groups. In all patients lumber puncture was performed at the L2-3 interspace, subarachnoid injection of bupivacaine 15 mg and then the catheter was inserted upward 5 cm. The anesthesia was maintained with epidural administration. At the end of operation the patients were received respectivel A （0.15%levobupivacaine）, B （0.125% levobupivacaine ＋ 2 μg/mL fentanyl） and C （0.075%levobupivacaine＋2 μg/mL fentanyl） groups of continuous epidural analgesia pump input analgesia. BP, HR, ECG and SpO 2, the local anesthetic, the spread level of analgesia, Bromage scale, Visual analog scale, Ramsay sedation scale, Bruggrmann comfort scale （BCS） and Patients satisfaction scores （PSS） were monitored during and post the surgery.Adverse events were observed and compared. Results The groups were demographically the same and did not differ in the local anesthetic、 the sensory block and motion block and SpO2. BP HR declined during 5-10 minutes after the injection of local anesthetic initial volume or postoperation 6 h （P 〈0.01） and 24 h （P 〈0.05）. When the patients were quiet within 48 h VAS score showed no significant difference, VAS score of activities in unit hours comparison within group and between group B group compared with A group and C group were significantly different postoperative 24 h （P 〈0.01） or marked 48 h （P〈0.05）, Ramsay sedation score B, C group was better than A group （P 〈0.01）. BCS （P〈0.05） or PSS （P 〈0.01） in B group than in A group and C group, A group than in the B group less side effects. Conclusion Postoperative epidural 0.125% levobupivacaine ＋2 μg/mL fentanyl has better sedation and pain relief

关 键 词：左旋布比卡因 腰硬联合麻醉 患者自控硬膜外镇痛 子宫切除术 

分 类 号：R614[医药卫生—麻醉学]