左旋布比卡因用于子宫动脉栓塞围治疗期硬膜外镇痛和对患者康复的影响  

Effects of levobupivacaine on patient controlled epidural analgesia and on recovery of patients during and after uterine arterial embolization

作　　者：佘守章[1] 许学兵[1] 许立新[1] 陈春林[2] 刘继云[1] 谢晓青[1] 

机构地区：[1]广州市第一人民医院麻醉科,广东省广州市510180 [2]广州市第一人民医院妇产科介入治疗中心,广东省广州市510180

出　　处：《中国临床康复》2004年第17期3217-3219,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:研究2g/L左旋布比卡因用于子宫动脉栓塞(UAE)围介入治疗期硬膜外自控镇痛(PCEA)的镇痛效应、不良反应和对患者康复质量的影响。方法:自愿行UAE介入治疗的子宫肌瘤或腺肌病患者80例(ASAⅠ～Ⅱ级),随机分成3组,L组(n=30):采用PCEA法,镇痛药2g/L左旋布比卡因(LBup)+0.04g/L吗啡(Mor)+0.02g/L氟哌利多(Dro),PCA以LCP模式给药,即负荷剂(6mL)+持续剂量(2mL/h)+PCA剂量(2mL/次),锁定时间10min;R组(n=30):镇痛药为2g/L罗哌卡因(Rop)+0.04g/LMor+0.02g/LDro,PCEA方法同L组;C组(n=20,对照):用传统口服药物或肌注盐酸哌替啶法镇痛。双盲观察各组疼痛视觉模拟评分(VAS)、BCS舒适评分、Ramesay评分、术后恢复以及恶心、呕吐、皮肤瘙痒等并发症情况。结果:UAE手术操作期间C组患者盆腔疼痛和继发性痛性痉挛发生率为90%,远高于L组和R组;介入治疗后L组和R组VAS评分、BCS评级明显优于C组(P<0.05)。L组和R组术后下床时间平均为(15.1±4.6)h,C组则为(27.9±6.7)h(P<0.05);L组和R组平均总住院时间为(10.3±2.7)d,而C组平均总住院时间为(13.6±3.9)d(P<0.05);围介入治疗期C组患者烦躁不安发生率较L组和R组多;恶心发生率C组高于其他两组(P<0.05)。结论:UAE围介入治疗期2g/L左旋布比卡因用于PCEA法镇痛效果好,术后恢复快。AIM:To study the analgesic effects and adverse reactions of 2 g/L levobupivacaine on patient controlled epidural analgesia(PCEA) during and after interventional therapy of uterine arterial embolization(UAE),and explore its effect on the quality of rehabilitation in patients. METHODS:Eighty patients(ASAⅠ-Ⅱgrade) undergoing transcatheter uterine myomata or adenomyoma voluntarily,were randomly divided into 3 groups:group L and R(n=30),who received PCEA and group C(n=20),who was either given oral drugs of micronized nimesulide,or intramuscularly injection of pethidine hydrochloride,or both.The prescription of PCEA of group L and R were 2 g/L levobupivacaine+0.04 g/L morphine(Mor)+0.02 g/L droperidol(Dro) and 2 g/L ropivacaine+0.04 g/L Mor+0.02 g/L Dro.The same LCP model of PCEA was adopted, that was loading dose(6 mL)+continuous infusion(2 mL/hour)+bolous(2 mL) with locking time 10 minutes.The visual analogue score(VAS),Bruggman comfort scale(BCS),Ramesay score,recovery time,and complications(nausea,vomiting,itch of skin,etc.) of each group were recorded and compared. RESULTS:The incidence of pelvic pain and secondary cramp was 90%in group C,much higher than that in group L and R during UAE procedure.The VAS score and BCS grading of group L and R were significantly lower than those of group C after UAE(P< 0.05).The patients of group L and R showed quiet and corporation(Ramesay score 2) contrary to anxious and agitated(Ramesay score 1) in group C. The average time for getting out of bed in group L and R was (15.1±4.6 ) hours,significantly shorter than that of group C[(27.9±6.7) hours](P< 0.05);The average time until discharge in group L and R were (l0.3±2.7) days,shorter than that of group C[(13.6±3.9) days](P< 0.05).The incidence of dysphoria in group C was higher than that in group L and R during and after UAE and after UAE,the rate of nausea in group C was higher than that in group R and C(P< 0.05). CONCLUSION:PCEA by using 2 g/L levobupivacaine has the advantages of good analgesic effect and fast pos

关 键 词：左旋布比卡因 子宫动脉栓塞 围介入治疗期 康复 硬膜外自控镇痛 不良反应 子宫肌瘤 

分 类 号：R737.33[医药卫生—肿瘤] R971.2[医药卫生—临床医学]