0.2%罗比卡因和0.15%布比卡因用于胸科手术后病人自控硬膜外镇痛  

Patient-controlled epidural analgesia (PCEA)with 0.2% ropivacaine or 0.15% bupivacaine in patients after thoracic surgery

作　　者：孙颖[1] 冯艺[1] 杨拔贤[1] 武力民 田伟[1] 曾广辉 施英[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《临床麻醉学杂志》2002年第10期527-530,共4页Journal of Clinical Anesthesiology

摘　　要：目的　评价 0 2 %罗比卡因加 2 μg/ml芬太尼与 0 15 %布比卡因加 2 μg/ml芬太尼用于胸科手术后病人自控硬膜外镇痛 (PCEA)的效果及不良反应。方法　 32例ASAⅠ～Ⅲ级择期胸科手术病人 ,采用丙泊酚静脉全麻复合硬膜外麻醉。术后随机分为两组 :R组 (n =16 )给予 0 2 %罗比卡因加 2 μg/ml芬太尼 ;B组 (n =16 )给予 0 15 %布比卡因加 2 μg/ml芬太尼。行PCEA ,持续镇痛治疗 72小时 ,由不知情观察者每 4小时记录一次安静及咳嗽时的疼痛VAS评分、血压、心率及SpO2 。每 2 4小时记录全天有效按压次数、所用药量、最痛时的VAS评分及不良反应 ,并由病人评价镇痛效果的满意度。结果　两组病人术后第 1天VAS评分分别为 :安静时R组 (1 1± 1 5 )分 ,B组为 (1 0± 1 4 )分 ;咳嗽时R组 (3 2± 2 0 )分 ,B组 (3 4± 1 3)分 ;最痛程度R组 (4 5± 2 6 )分 ,B组 (4 6±1 6 )分 ,满意度均为 3(2～ 4 )。术后第 2天和第 3天VAS评分及镇痛满意度与第 1天类似。两组安静、咳嗽及最痛时的VAS评分、患者自评镇痛满意度、总用药量及PCEA量差异无显著性 (P >0 0 5 )。术后第 2天最低平均动脉压R组 (83± 7)mmHg ,B组 (75± 11)mmHg ,第 3天最低心率R组(87± 8)次 /分 ,B组 (78± 9)次 /分 ,B组均低于R组 (P <0 0 5 )。?Objective To evaluate and compare the effects of 0 2% ropivacaine with 2μg/ml fentanyl and 0 15% bupivacaine with 2μg/ml fentanyl for patient controlled epidural analgesia(PCEA) after thoracic surgery.Methods 32 ASA physical status Ⅰ Ⅲ patients undergoing elective thoracic surgery received propofol general/epidural anesthesia.After surgery patients were randomly allocated in a double blind fashion into two groups:PCEA(Baxter APⅡ pump)with either 0 2% ropivacaine and 2μg/ml fentanyl (group R, n= 16)or with 0 15% bupivacaine and 2μg/ml fentanyl(group B, n= 16).Dynamic visual analogue pain scale(VAS) during rest or coughing,pulse oxymetry(SpO 2),hemodynamic variables were evaluated every 4 hours.Occurrence of untoward events,respiratory complications,satisfaction of patients to pain relief,as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded within three postoperative days.Results VAS of group R and group B were 1 1±1 5 and 1 0±1 4 at rest,and 3 2±2 0 and 3 4±1 3 at cough respectively.Satisfaction of patients to pain relief was all good.VAS,satisfaction,total consumption of PCEA solution,incremental doses given to the patient and SpO 2 were not significantly different between two groups ( P> 0 05).MAP was significantly decreased on the second postoperative day in both groups,and HR was significantly lower in group B on the third day after surgery ( P< 0 05).Conclusions Either 0 2% ropivacaine combined with 2μg/ml fentanyl or 0 15% bupivacaine with 2μg/ml fentanyl can provide satisfactory postperative PCEA without significant side effects in thoracic surgical patients. [

关 键 词：自控硬膜外镇痛 罗比卡因 布比卡因 芬太尼 胸外科 不良反应 疗效 

分 类 号：R614.42[医药卫生—麻醉学]