罗比卡因术后镇痛对老年人呼吸、循环和肠道功能的影响

目的 观察罗比卡因复合芬太尼硬膜外持续输注镇痛对老年人上腹部手术后呼吸、循环和胃肠道功能的影响。方法45例ASAⅡ～Ⅲ级、年龄≥65岁的择期手术患者，随机分为罗比卡因组（R组）、布比卡因组（B组）和对照组（C组）。观察并记录患者NIBP、HR、RR、MV、SpO2，镇痛评分（VAS）、舒适评分（BCS）、肛门首次排气时间以及不良反应。结果R组和B组均取得了良好的镇痛效果，VAS疼痛评分均明显低于对照组（P〈0．01），BCS舒适评分均显著高于对照组（P〈0．01）。R组患者术后各时点的呼吸、循环功能均无显著性改变；B组术后8h时SBP和MV明显降低，RR和HR显著增快；C组患者术后呼吸变浅增快，心率增快，SBP升高，且SpO2在术后8h有明显的降低。R组和B组的肛门排气时间早于对照组，胃肠蠕动功能恢复明显提前。结论老年人腹部手术后采用罗比卡因复合芬太尼硬膜外持续输注镇痛，镇痛效果确切，对呼吸循环影响小，促进胃肠道蠕动功能的恢复，有利于老年人术后早期康复。

Effect of Ropivacaine for Postoperative Analgesia on Respiration, Circulation and Intestinal Peristalsis in Elderly

Objective To compare the effects on respiration, circulation and intestinal peristalsis of ropivacaine combined with fentanyl for postoperative analgesia in elderly. Methods Forty-five patients over 65 years, ASA grade Ⅱ-Ⅲ, scheduled for surgery, were randomly assigned to three groups： group R and group B receiving continuous injection of 0. 125% Ropivacaine or 0. 125% Bupivacaine ＋ 0. 00030% fentanyl at the rate of 2 ml/h for 50 h, and control group （group C, without analgesia）. The pain scores of visual analogue scale （VAS）, bruggrmmann comfort scale （BCS）, respiratory and hemodynamic parameters, and side effects were recorded every 4 h postoperatively. The time of the recovery of intestinal peristalsis was also recorded. Results Postoperative analgesia was satisfactory in groups R and B, VAS score in groups R and B was lower than that in group C （P〈0. 01）, and BCS score in groups R and B was higher than that in group C （P〈0. 01）. There were no significant changes of respiratory and hemodynamic parameters in group R. SBP and MV in group B were decreased significantly, while RR and HR were increased obviously 8 h after operation. In group C, respiration became lighter and quicker, RR and SBP increased, but SpO2 decreased significantly 8 h after operation The time of the recovery of intestinal peristalsis was shorter in groups R and B than that in group C. Conelusion Epidural continuous infusion of compound solution of ropivacaine and fentanyl at low concentration results in satisfactory analgesia and few side effects in elderly patients who had undergone upper abdominal surgery, earlier recovery of intestinal peristalsis and earlier postoperative rehabilitation.