不同剂量及容量的麻醉药对踝关节术后硬膜外镇痛效果的影响

目的探讨硬膜外给予不同剂量及容量麻醉药对骨科踝关节手术患者术后镇痛效果的影响。方法选取连续硬膜外麻醉下行踝关节手术的患者60例，随机分为三组，每组20例，术后均予以硬膜外镇痛，方案分别为：I组：甲磺酸罗哌卡因0．149％＋芬太尼2μg／mL＋氟哌利多25μg/mL，给药速度为2mL／h；l／组：甲磺酸罗哌卡因0．298％＋芬太尼2阻g／mL＋氟哌利多25μg／mL，给药速度为2ml/h；Ⅲ组：甲磺酸罗哌卡因0．149％＋芬太尼1μg／mL＋氟哌利多12．5μg／mL，给药速度为4mL/h。采用VAS镇痛评分和Ramsay镇静评分对患者术后4h、8h、12h、24h、48h进行疼痛和镇静评分并记录患者恶心、呕吐、头晕、瘙痒、尿潴留、运动障碍、感觉障碍等副作用。结果Ⅲ组与I、Ⅱ组相比，术后8h、12h、24hVAS评分显著降低（P〈0．05）；Ⅱ组VAS评分较I组低，但无统计学意义。Ⅱ组出现尿潴留4例、运动障碍1例、感觉障碍2例，与I、Ⅲ组相比有统计学差异。结论踝关节手术后硬膜镇痛，局麻药剂量相同、容量不同时，高容量较低容量镇痛效果佳。

Effects on Epidural Analgesia with Different Capacity and Dose of the Anesthetic after Ankle Surgery

Objective To investigate the postoperative analgesic effects of epidural anesthesia with different capacity and dose of the anesthetic after orthopedic ankle surgery. Methods Sixty patients undergoing ankle surgery with continuous epidural anesthesia,were randomly divided into three groups （n=20 each）,Group I ： 0.149% ropivacaine＋fentanyl 2μg/mL ＋ droperidol 25μg/mL,dose rate of 2mL/h; GroupⅡ：0.298% ropivacaine ＋ fentanyl 2μg/mL ＋ droperidol 25μg/mL, dose rate of 2mL/h;Group m： ropivaeaine 0.149% ＋ Fentanyl 1 μg/mL ＋ droperidol 12.5μg/mL, dose rate of 4mL/h. Pain and sedation were respectively assessed with VAS pain score and Ramsay sedation score, and the side effects including nausea,vomiting,dizziness,itching,anesthesia and dyskinesia were recorded in patients at 4h,8h,12h,24h after surgery. Results Compared to Group I and Group l] ,patients in Group m have significantly lower VAS score at postoperative 8h, 12h,24h （P〈0.05）;VAS score in Group Ⅱ was lower than in Group I ,but without statistical significance. Compared to Group Ⅱ and Group m ,the adverse reactions of nausea,vomiting,dizziness,anesthesia and dyskinesia in Group Ⅱ were statistically different. Conclusion After ankle surgery, effects on epidural analgesia are associated with the capacity of anesthetic,which means that the more capacity, the better analgesic effect.