悬雍垂腭咽成型术应用0.75%盐酸罗哌卡因镇痛的临床效果观察

目的 观察0.75%盐酸罗哌卡因局部浸润应用于悬雍垂腭咽成型术（UPPP）术后镇痛效果及镇痛持续时间.方法 选择睡眠呼吸暂停低通气指数（AHI）25～45行UPPP的患者50例,完全随机分为罗哌卡因组和氯化钠注射液组,每组25例.罗哌卡因组手术开始时于双侧扁桃体舌腭弓上、中、下3点各注入0.75%盐酸罗哌卡因2 ml;氯化钠注射液组注入0.9%氯化钠注射液各2 ml.术后2组均以舒芬太尼100 μg＋0.9%氯化钠注射液100 ml镇痛泵输注持续镇痛,背景剂量2 ml/h,单次追加剂量0.5 ml,间隔时间15 min.术后2、6、12、24、36 h记录2组患者的镇痛视觉模拟评分（VAS）及舒芬太尼单次追加次数.结果 罗哌卡因组术后2、6、12、24、36 h VAS均明显低于氯化钠注射液组（1.9±0.5）分比（3.4±1.5）分,（1.6±1.2）分比（3.8±1.6）分,（1.7±1.3）分比（3.6±1.2）分,（1.7±1.6）分比（2.9±0.8）分、（0.5±0.2）分比（2.6±0.2）分,均P〈0.05];在2、6、12 h舒芬太尼单次追加次数均明显少于氯化钠注射液组（1.8±0.2）次比（3.0±0.5）次,（1.5±0.3）次比（3.2±1.4）次,（1.5±0.6）次比（2.5±0.2）次,均P〈0.05].罗哌卡因组术后2、6 h脉搏血氧饱和度及呼吸频率高于氯化钠注射液组,差异有统计学意义（97.2±2.5）%比（95.2±3.6）%、（97.2±2.1）%比（95.3±4.8）%,（16.3±2.3）次/min比（13.3±2.3）次/min、（17.1±3.2）次/min比（13.4±5.8）次/min]（P〈0.05）.结论 0.75%盐酸罗哌卡因局部浸润应用于UPPP,能提供良好的术后镇痛效果,且减少阿片类药物的用量,减少围术期低氧血症的发生.

Observation of the effect of 0.75% ropivacaine hydrochloride used in uvulopalatopharyngoplasty analgesia

Objective To observe the effect and duration of 0.75% ropivacaine local infiltration used in uvulopalatopharyngoplasty （UPPP） in postoperative analgesia. Methods Fifty UPPP patients with sleep apnea hypopnea index （AHI） of 25-45 were randomly divided into ropivacaine group and 0.9% sodium chloride injection group; there were 25 cases in each group. Three points of bilateral amygdala palatoglossal arch were injected 0.75% ropivacaine hydrochloride 2 ml in ropivacaine group before operation; 0.9% sodium chloride injection group had were injected 0.9% sodium chloride injection 2 ml.After operation in the 2 groups with sufentanil 100 μg＋0.9% sodium chloride injection 100 ml analgesia pump infusion analgesia, background dose 2 ml/h, single dose 0.5 ml, 15 min interval. Pain visual analog scale and sufentanil single additional times were recorded scores of at 2, 6, 12, 24, 36 h after operation. Results The dynamic visual analogue scale at 2, 6, 12, 24, 36 h after operation in ropivacaine group were significantly lower than those in the 0.9% sodium chloride injection group（1.9±0.5）scores vs （3.4±1.5） scores （1.6±1.2） scores vs （3.8±1.6） scores, （1.7±1.3） scores vs （3.6±1.2） scores, （1.7±1.6） scores vs （2.9±0.8） scores, （0.5±0.2） scores vs （2.6±0.2） scores]（P〈0.05）. Oxygen saturation and respiratory frequencies in ropivacaine group were higher than those in 0.9% sodium chloride injection group at 2, 6 h after operation; the difference was significant（97.2±2.5）% vs （95.2±3.6）%,（97.2±2.1）% vs （95.3±4.8）%; （16.3±2.3）bpm vs （13.3±2.3）bpm,（17.1±3.2）bpm vs （13.4±5.8）bpm]（P〈0.05）. Conclusion Local infiltration 0.75% ropivacaine can provide good postoperative analgesia effect, reduce opioid dosage and the incidence of perioperative hypoxemia in UPPP.