舒芬太尼联合罗哌卡因行椎管内术后硬膜外镇痛的疗效观察  

THE EFFICACY OF SUFENTANIL COMBINED WITH ROPIVACAINE FOR THE CONTINUOUS EPIDURAL ANALGESIA IN PATIENTS AFTER RESECTION OF INTRASPINAL TUMORS

作　　者：胡正芳[1] 于斌[1] 王云珍[1] 罗芳[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100050

出　　处：《中国疼痛医学杂志》2017年第10期754-758,共5页Chinese Journal of Pain Medicine

基　　金：北京市卫生系统高层次人才(学科骨干)项目(No.2014-3-035)

摘　　要：目的:探讨舒芬太尼联合罗哌卡因应用于脊髓肿瘤切除术后持续硬膜外镇痛的疗效。方法:选择ASA I-II级、全凭静脉麻醉下行中胸段及以下脊髓肿瘤切除手术病人40例,随机分为两组,每组20例,所有病人在术后均行硬膜外置管并连续输注镇痛液进行镇痛治疗,配方为A组:0.25μg/ml舒芬太尼+0.15%罗哌卡因,负荷量10 ml,持续速率4 ml/h;B组:0.25μg/ml舒芬太尼+0.2%罗哌卡因,负荷量10 ml,持续速率2 ml/h。对两组病人在术后4、12、24和48 h分别进行疼痛的视觉模拟评分(visual analogue scale,VAS)、身体舒适度评分(bruggrmann comfort scale,BCS)和镇静评分(Ramsay)进行评估,同时观察各组的肌力及尿潴留等并发症。结果:两组病人在术后4、12、24和48 h各个时间段,其VAS、BCS和镇静评分均无显著性差异;B组有4例病人(20%)术后4 h出现下肢麻木感,伸直下肢不能抬离床面,1例病人出现尿潴留,A组未观察到相关不良反应。结论:0.25μg/ml舒芬太尼+0.15%罗哌卡因4 ml/h的速率和0.25μg/ml舒芬太尼+0.2%罗哌卡因2 ml/h的速率对脊髓肿瘤切除术后持续硬膜外镇痛效果一致,但后者有可能出现感觉、运动阻滞及尿潴留,不建议临床应用。0.25μg/ml舒芬太尼+0.15%罗哌卡因4 ml/h的速率对于脊髓肿瘤切除病人术后镇痛是比较安全有效的选择。Objective： To investigate the efficacy of sufentanil combined with ropivacaine for continuous epidural analgesia in patients after the resection of intraspinal tumors. Methods： Forty patients with ASA grade I-II undergoing the resection of middle or lower -thoracic tumor under total intravenous anesthesia were randomly divided into two groups （n = 20 each group）. Group A： Patients received a consistent epidural infusion of 4 ml/h sufentanil （0.25 μg/ml） combined with ropivacaine （0.15%） after surgery. Group B： Patients received 2 ml/h sufentanil （0.25 μg/ml） combined with ropivacaine （0.2%） instead. The patients in each group received an initial bolus of I0 ml at first. The analgesia effect and safety were evaluated. Results： At 4, 12, 24 and 48 h after surgery, the visual analogue scale （VAS） pain score, the ramsay sedation score, and the bruggrmann comfort scale （BCS） score showed no significant difference between the groups. Four patients （20%） complained of extremity numbness and their bilateral legs could not lift from the bed when extending legs at 4 h after surgery in Group B. Retention of urine was occurred in one patient of Group B. There was no obvious side effect in group A. Conclusion： In patients after the resection of intraspinal tumors, the infusion of 4 ml/h sufentanil （0.25 μg/ml） combined with ropivacaine （0.15%） and the infusion of 2 ml/h sufentanil （0.25 μg/ml） combined with ropivacaine （0.2%） have the similar analgesia effects. However, the latter one may cause sensation and movement blockade as well as retention of urine. The infusion of 4 ml/h 0.25 μg/ml sufentanil combined with 0.15% ropivacaine is sμtggested as a safety analgesia option for patients after the resection of intraspinal tumors.

关 键 词：罗哌卡因 舒芬太尼 脊髓手术 硬膜外镇痛 

分 类 号：R614[医药卫生—麻醉学]