不同浓度罗比卡因复合吗啡用于剖宫产术后硬膜外自控镇痛的效果评价

目的:用不同浓度的罗比卡因复合吗啡行剖宫产术后硬膜外自控镇痛,以寻求合适浓度罗比卡因复合低浓度吗啡,用于下腹部术后硬膜外自控镇痛。方法:80例ASAⅠ~Ⅱ级剖宫产术后病人,硬膜外导管分别留置于L1~2椎间隙,向上3·0cm,2%利多卡因维持术中麻醉,将上述产妇随机分为四组:①0·05%罗比卡因+0·004%吗啡(R0·05组);②0·1%罗比卡因+0·004%吗啡(R0·1组);③0·2%罗比卡因+0·004%吗啡(R0·2组);④0·125%布比卡因+0·004%吗啡(B组),每组各20例。观察产妇24h内心率、血压、呼吸频率,VAS,镇静评分,PrineHenry评分,改良Bromage分级的变化;以及恶心、呕吐,皮肤瘙痒,延迟排气,尿潴留的发生率和子宫复旧、阴道出血情况;并记录四组产妇24h内总用药量。结果:血压、心率、呼吸频率、血氧饱合度四组病人无显著性差异,改良Bromagescale:B组>R0·2组>R0·1组或R0·05组(P<0·05),尿潴留、延迟排气发生率B组>R0·2组>R0·1组或R0·05组(P<0·05),吗啡用量R0·05组>R0·1组>R0·2组>B组(P<0·05)。四组患者子宫复旧、阴道出血情况无显著性差异。结论:0·1%、0·05%罗比卡因复合低浓度吗啡能够产生良好的镇痛效果,运动阻滞程度小,是一种理想的适合于下腹部手术术后硬膜外自控镇痛方法。

Evaluation of different concentrations of ropivacaine combined with morphine for patient- controlled epidural analgesia

Objective:Different concentrations of ropivacaine were combined with morphine for patients-controlled epidural analgesia (PCEA) after cesarean section to search for proper concentration of ropivaeaine. Combined with morphine for PCEA after lower abdominal operations. Methods:The subiects were 80 ASA Ⅰ-Ⅱ patients accepting cesarean section. The epidermal catheter was located in LR1-2 inter-spinal space,30 cm pointing upward. They were randomized into 4 groups (n=20):0.05% Rapivacaine + 0.004% morphine (Group R_ 0.05 );0.1% ropivacaine+0.004% morphine (Group R_ 0.1 );0.2% Ropivacaine+ 0.004% Morphine (Group R_ 0.2 ) and 0.125% Bupivacaine+0.004% morphine (Group B).Hemodynamic data, VAS, SS, Bromage scale, side effects and analgesic consumption of all the patients were recorded. Results:No difference among the groups was found in blood pressure (BP),heart rate (HR),respiratory rate (RR) and SpO_2. Optimized Bromage scale: Group B>Group RR_ 0.2 >Group R_ 0.1 or Group R_ 0.05 (P<0.05);side effects:the incidence of urinary retention and delayed exsufflation: Group B>Group R_ 0.2 >Group R_ 0.1 or Group R_ 0.05 .Morphine consumption: Group R_ 0.05 >Group R_ 0.1 >Group R_ 0.2 >Group B. Conclusion:A satisfactory analgesic effect can be produced by the combination of 0.1% or 0.05% Ropivacaine and low dose morphine, accompanying with slight meter block. This combination is quite appropriate for PCEA after lower abdominal operations.