不同浓度罗比卡因伍用吗啡术后PCEA对病人通气功能的影响

目的 比较不同浓度罗比卡因（Rop)伍用吗啡（Mor)用于子宫切除术后病人硬膜外自控镇痛（PCEA）对通气功能的影响。方法 45例病人随机分成R1、R2和R0组（n=15)，镇痛药分别为0．1％Rop、0．2％Rop和0．9％氯化钠配伍0．01％Mor,行术后PCEA。双盲观察比较各组通气功能并进行视觉模拟疼痛评分（VAS）。结果 与术前相比，三组病人通气功能均有所下降，表现为VT降低，RR加快。其程度R0组≥R1组＞R2组，而MV则无明显变化。PCEA期间R2组通气功能稳定。PCA泵启动后与启动前相比，R0组、R1组能气功能仍有明显下降，R0组变化更为明显。各组PETCO2、SpO2、F1－EO2等指标数值有所变化，但无统计学意义。R2组镇痛效果优于R1组R0组。三组病人VT、RR与VAS分值有明显相关性，相关系数分别为－0．89、0．80（P＜0．05）。结论 0．2％Rop伍用低浓度Mor行PCEA镇痛效果好，有利于改善病人术后能气功能。

Comparison of the effects of postoperative PCEA with ropivacaine in different concentrations combined with low dose morphine on ventilatory function

Objectlve To compare the ventilatory function (VF)during postoperative patient-controlled epidural analgesia (PCEA) with ropivacaine (Rop)in different concentrations combined with 0.01%morphine (Mor)after hysterectomy. Methods Forty-five patients undergoing hysterectomy were divided into group R1, R2 and R0, and the three groups were respectively scheduled for PCEA with 0.1% Rop,0.2% Rop and 0.9% normal saline combined with 0.01% Mor. The VF, visual analog score (VAS)and modified bromage stage were double blindly recorded and evaluated in 3 groups at specially designed time points. Resmlts Compared with the values before operation, the postoperative VF of the 3 groups were all declined manifested by a decrease of Vt and an increase of RR in a sequence of group R0≥group R1 >group R2, while the MV were not statistically changed. During PCEA, VF of group R2 maintained stablly during PCEEA, while the VF of group R0 and R1 decreased significantly after PCEA pump started compared with that before PCEA. The PETCO2, SpO2, FI-EO2 in 3 groups had no obvious changes. The analgesic effect of group R2 was superior to that of group R0 and R1 (P < 0.05). The VT and RR had alinear relationship with VAS score (r = -0.89 and 0.80 respectively)(P < 0.05). Conclusion 0.2% Rop combined with 0.01% Mor provides an excellent analgesic effect and benefits to the postopertive VF.