0.15％左旋布比卡因用于子宫全切术后硬膜外自控镇痛的临床观察

目的:比较0.15%左旋布比卡因和布比卡因用于经腹子宫全切术后患者自控硬膜外镇痛(PCEA)的临床效应.方法:择期经腹子宫全切术患者60例随机分成左旋布比卡因组(L组,n=30)和布比卡因组(B组,n=30)进行PCEA,观察患者24h镇痛效果、运动阻滞情况及不良反应.结果:两组视觉模拟评分(VAS)、舒适评级(BCS)相似,而24h硬膜外用药量、24h按压次数/实际有效进药次数(D/D)比值及PCA按压次数B组＞L组(P＜0 05);术后运动阻滞完全恢复时间,术后4h、8h、12h运动恢复分级两组差异无显著性;低血压发生率L组明显低于B组,差异有显著性(P＜0.05).结论:0.15%左旋布比卡因用于PCEA能达到满意镇痛效应,并减少局麻药及芬太尼用量,术后不良反应较少,安全性高;运动神经阻滞与布比卡因相同,作用时间较长.

Clinical Observation of 0.15% Levobupirvacaine for Patient Controlled Epidural Analgesia after Total Abdominal Hysterectomy

OBJECTIVE: To compare the effect of 0.15% levobupirvacaine and bupirvacaine in patient controlled epidural analgesia (PCEA) after total abdominal hysterectomy (TAH). METHODS: Sixty patients after elective TAH were randomly divided into two groups, to receive PCEA by levobupirvacaine (group A, n=30) or bupirvacaine (group B, n=30). Analgesia effect, block of motor nerve and incidence of side-effect were observed. RESULTS: VAS score and BCS score in two groups were similar. Total drug dosage, D/D ratio and number of PCEA attack were higher in group B compared with Group A ( P <0.05). There was no significant difference between two groups in recovery time of motor nerve block and bromage score 4hours, 8hours, 12hours after operation. The incidence of low blood pressure in group A was significantly lower than that in group B. There was a obvious difference between two groups( P <0.05). CONCLUSION: 0.15% levobupirvacaine for PCEA under LCP mode can obtain satisfactory analgesia effect and decrease the dosage of local anesthesia drugs and fentanyl. It has also less side effect and high safety. The effect of motor nerve block by levobupirvacaine is the same as that by bupirvacaine, but the former can act longer time.