不同浓度地佐辛用于全子宫切除术后硬膜外镇痛效果比较

目的 比较不同浓度地佐辛用于全子宫切除术后硬膜外自控镇痛(PCEA)的临床效果和不良反应.方法 将择期行全子宫切除术患者150例随机分为五组,每组30例,L组给予0.2％罗哌卡因；M组给予吗啡10 mg、0.2％罗哌卡因；D1组给予地佐辛5 mg、0.2％罗哌卡因；D2组给予地佐辛10 mg、0.2％罗哌卡因；D3组给予地佐辛15 mg、0.2％罗哌卡因；镇痛药总量均为150 mL,给药模式均采用负荷剂量5 mL,背景流速2 mL/h,单次按压术后自控镇痛泵(PCA)追加剂量1 mL,锁定时间15 min.观察术后第1、4、8、12、24小时各时间点的静息疼痛并进行视觉模拟疼痛(VAS)评分,记录PCEA期间各种不良反应.结果 M组术后4、8、12h各时间点VAS评分和PCA平均有效按压次数比L、D1组低,差异有统计学意义(P＜0.05),而与D2、D3组比较,差异无统计学意义(P＞0.05),术后1、24 h五组患者VAS评分比较,差异无统计学意义(P＞0.05).M组患者恶心、呕吐发生率与D3组比较,差异无统计学意义(P＞0.05),但比L、D1、D2组高,差异有统计学意义(P＜0.05).结论 地佐辛10 mg、0.2％罗哌卡因用于术后PCEA效果确切,不良反应少.

Effective comparison of different concentrations of dezocine used in postoperative epidural analgesia after panhysterectomy

Objective To compare the clinical effect and adverse reactions of different concentrations of dezocine used in patient controlled epidural analgesia（PCEA） after panhysterectomy.Methods 150 cases of elective panhysterectomy were randomly divided into 5 groups with 30 cases in each group,the group L was given with 0.2% ropivacaine,the group M with morphine 10 mg plus 0.2% ropivacaine,the group D1 with dezocine 5 mg plus 0.2% ropivacaine,the group D2 with dezocine 10 mg plus 0.2% ropivacaine and the group D3 with dezocine 15 mg plus 0.2% ropivacaine.The total analgesic dose was 150 mL.The adminstration mode adopted the loading dose of 5 mL,the background flow of 2mL/h,the single press additional（PCA） dose of 1mL and the lockout time of 15 min.To observe resting pain and conduct the VAS scoring at postoperative 1,4,8,12,24 h and record various adverse reactions during PCEA.Results The VAS scores at postoperative 4,8,12 h and the PCEA average effective compression frequency in the group M were lower than those in the group L and D1with statistical difference（P〈0.05）,but there was no statistical difference compared with the group D2 and D3（P〈0.05）.THe VAS scores at postoperative 1,24 h had no statistical difference among 5 groups（P〈0.05）.The incidence rate of nausea and vomiting had no statistical difference between the group M and D3（P〈0.05）,but which was higher than that in the group L,D1 and D2,showing statistical differenceamong them（P〈0.05）.Conclusion Dezocine 10 mg and 0.2% ropivacaine for postoperative PCEA has definite effect and less adverse reactions.