硬膜外术后镇痛效果取决于药物的剂量还是容量

目的:比较单位时间药量相等容量不等的硬膜外术后镇痛效果,探讨硬膜外镇痛的效果是主要依赖药物的剂量还是容量。方法:150例行下腹部或下肢手术病人,ASA I~II级,于腰麻硬膜外联合麻醉术后行硬膜外持续镇痛,随机分为3组(n=50)。镇痛药配方及用法为I组:0.0005%的芬太尼+0.0625%的布比卡因,持续流速为5mL/h;II组:把I组药物的流速改为2mL/h;III组:流速同II组,但单位时间用药量提高到I组水平。观察术后48h的VAPS镇痛评分、病人满意评分及副反应情况。结果:术后48h持续硬膜外镇痛,3组VAPS评分,I组和III组0~4分者均在80%以上,两组间比较无差异,而且两组均与II组构成显著性差异(P<0.05);II组VAPS评分0~4者仅为44%。病人满意评分结果与VAPS评分结果基本一致。结论:硬膜外术后镇痛的效果主要取决于药物的剂量而非容量。

Effectiveness of Postoperative Epidural Analgesia Depends on Volume or Dose of the Drugs

Objective:To compare the effects of postoperative epidural analgesia with equal doses but different volumes of Fentanyl and Bupivacaine in the same period and observe the effect of postoperative epidural analgesia depends on dose or volume of the drugs.Methods:150 patients of lower abdominal or pelvic limb surgery underwent combined spinal epidural anesthesia and postoperative epidural analgesia were randomly divided into three groups.Group I: 0.0005% Fentanyl and 0.0625% Bupivacaine continuous epidural infusion at the rate of 5ml/h;Group II: the concentration of the drugs was the same with group I,but infusion rate was 2ml/h;Group III: the infusion rate was the same with group II,but the dose of the drugs was equal to group I.VAPS and the satisfactory of patients were evaluated and recorded within 48h after the operation.Result:There were no signifficant differences between group I and group III on VAPS and the satisfactory of patients.But group II had a statistical difference compared with other groups(P<0.05).Conclusion:The effect of postoperative continuous epidural analgesia with Fentanyl and Bupivacaine will not mainly depend on the volume but the dose of the drugs.