芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的比较

目的：比较芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的效果及不良反应的发生率。方法：择期肿瘤手术患者150例随机分为Ⅰ组、Ⅱ组、Ⅲ组各50例。Ⅰ组给予吗啡60—80μg／mL复合0．125％罗哌卡因100mL硬外镇痛；Ⅱ组给予芬太尼5-6μg／mL复合0．125％罗哌卡因100mL硬外镇痛；Ⅲ组单纯给予芬太尼20μg／kg静脉镇痛。比较三组术后不同时点VAS评分、Ramsay评分以及不良反应的发生率。结果：VAS评分三组间比较差异无统计学意义（P〉0．05）；Ⅲ组在术后12h、24h、48h的Ramsay评分显著高于其他组（P〈0．05）；恶心、呕吐、皮肤瘙痒的发生率Ⅱ组、Ⅲ组均显著小于Ⅰ组（P〈0．05）；头晕、嗜睡的发生率Ⅰ、Ⅱ组显著低于Ⅲ组（P〈0．05）。结论：芬太尼联合低浓度罗哌卡因用于术后硬膜外镇痛效果确切、不良反应发生率少。

A Comparison between Epidural Morphine and Fentanyl Combined with Ropivacaine for Postoperative Analgesia

Objective： To compare the analgesic efficacy and side effects of epidural fentanyl or morphine combined with 0.125% ropivacaine. Methods：150 cancer patients scheduled for different elective surgery were randomly divided into 3 groups. In group Ⅰ , patients received 0.125% ropivacaine combined with 60-80μg/mL of morphine for postoperative analgesia. In group Ⅱ ,patients received 0.125% ropivacaine combined with 5-6 μg/mL fentanyl for postoperative analgesia .In group Ⅲ , patients received a intravenous infusion of 20 μg/mg fentanyl at a rate of 2 mL/h for postoperative analgesia. Quality of analgesia and degree of sedation was assessed by VAS and Ramsay scores at 4h （T1）, 12b （T2）, 24h （T3） and 48h （T4） after surgery. Episodes of side effects were recorded. Results：The VAS pain scores have no significant difference between groups; Ramsay sedation scores of group Ⅲ were higher at 12 h, 24 h and 48 h after surgery compared with group Ⅰ and Ⅱ ; the incidences of nausea, vomiting, and pruritus were significant higher in group I and the incidences of dizziness, lethargy were significant higher in group Ⅲ compared with other groups, Conclusions：Epidural fentanyl combined with low concentration ropivacaine is feasible for postoperative analgesia, owing to effective analgesia and lower incidence of side effects.