吗啡、布比卡因及地塞米松配伍在痔瘘术后止痛的临床应用

目的　观察吗啡、布比卡因及地塞米松混合用药在痔瘘术后硬膜外止痛 (PEA)的疗效。方法　ASAⅠ～Ⅱ级 ,急诊或择期手术 80例 ,均采用 18G硬膜外穿刺针于L3～ 4 行硬膜外穿刺 ,向下置管 3cm ,先后注入 1.5 %利多卡因 5ml ,10ml,手术结束后于硬膜外导管一次性注入 0 .75 %布比卡因 2ml+地塞米松 10mg +吗啡 2mg混合液共 5ml,以视觉模拟评分法 (VAS)评定镇痛效果及术后 12 ,2 4,48h恶心呕吐、尿潴留发生率。结果　全组病人术后镇痛时效达 72h ,恶心呕吐发生率 10 % ,尿潴留发生率 12 %。结论　吗啡、布比卡因及地塞米松配伍在痔瘘术后硬膜外腔止痛疗效满意 ,且方法简便 ,经济、安全。

Clinical Application of Morphine, Bupivacaine and Dexamethasone Postopera- tion Epidural Analgesia for Hemorrhoids and Fistula

Objective To observe epidural analgesic effectiveness of dexamethasone combined with morphine and bupivacaine (DMB)after operation for hemorrhoids and fistula(HF).Methods 80 patients (ASAⅠ-Ⅱ)scheduled for selective and emergent surgery were under epidual anesthesia puctured at the level lumbar 3～4.then put into epidural catheter 3 cm towards spinal cord terminals.Local anaesthetic 1.5% lidocine 5ml were injected into the epidural space ,then injected 10 ml.The analgesic solutions DMB were slowly injection into epidural cavity after operation .Following the epidural catheter was withdrawed after injection.The VAS and the side effects such as nausea ,womiting and uroschsis were recorded at 12,24and 48h of postoperation.Results In this group the pain within 72 hour after operations was effectively controlled ,the rate of postoperative nauses ,vomiting and uroschsis were 10% and 12% respectively.Conclusion Epidural analgesic effectiveness of DMB postoperation for HF is satisfied and it is simple ,convenient ,economical and safe.