左旋布比卡因复合不同剂量舒芬太尼术后硬膜外自控镇痛临床对比研究

目的探讨和分析左旋布比卡因复合不同剂量舒芬太尼用于子宫切除术后硬膜外自控镇痛的临床效果、安全性及意义。方法收集拟行子宫切除术且ASAⅠ～Ⅱ级的患者135例,随机分为A、B和C组,各45例。三组术后均采用LCP模式镇痛,A组给予0.2%左旋布比卡因混合舒芬太尼0.4μg/mL;B组给予0.2%左旋布比卡因混合舒芬太尼0.6μg/mL;C组给予0.2%左旋布比卡因混合舒芬太尼0.8μg/mL。观察并记录各组患者镇痛泵开启前及开启后4、8、12及24 h的MAP、HR、视觉模拟法(VAS)评分、Ramsay评分、术后不良反应及并发症等情况。结果三组24 h舒芬太尼平均用量比较,差异均有统计学意义(均P<0.05);B组和C组镇痛效果于给药后8、12及24 h明显优于A组(P<0.05);B组和C组患者镇静效果于给药后12及24 h明显优于A组(P<0.05);与A组和B组相比C组患者出现恶心、呕吐及瘙痒等不良反应明显增多(P<0.05),B组和C组追加镇痛药患者显著少于A组(P<0.05)。结论经腹子宫切除术后硬膜外自控镇痛应用0.2%左旋布比卡因配伍舒芬太尼0.6μg/mL具有镇痛效果满意、安全性高和不良反应少等优点,值得临床推广。

Clinical comparative study on Levobupivacaine composite of different doses of Sufentanil for postoperative epidural controlled analgesia

Objective To explore and analyze the clinical effects of postoperative patient-controlled epidural analgesia,security and significance by Levobupivacaine composite of different doses of Sufentanil for hysterectomy.Methods 135 cases of patients who underwent hysterectomy and ASAⅠ-Ⅱwere divided into group A,B and C,each 45 cases.The three groups were used postoperative analgesia of the LCP mode.The patients of group A were given 0.2% Levobupivacaine mixed with Sufentanil 0.4 μg/mL;the patients of group B were given 0.2% Levobupivacaine mixed with Sufentanil 0.6 μg/mL;the patients of group C were given 0.2% Levobupivacaine mixed with Sufentanil 0.8 μg/mL.The MAP,HR,visual analog scale(VAS) score were observed and recorded,Ramsay score and postoperative adverse events and complications at the time of analgesia pump was turned on after 0,4,8,12 and 24 h.Results The three groups 24 h Sufentanil average amount were compared,and there were statistically significant(P < 0.05);8,12 and 24 h after administration of group B and group C patients with analgesic effect was better than group A(P < 0.05);group B and group C patients the sedative effect in 12 and 24 h after administration was significantly better than group A(P < 0.05);group A and group B compared to group C patients with adverse reactions including nausea,vomiting and itching increased significantly(P < 0.05);group B and group C appended patients with analgesics were significantly less than in group A(P < 0.05).Conclusion Abdominal hysterectomy postoperative patient-controlled epidural analgesia application of 0.2% Levobupivacaine combined with Sufentanil 0.6 μg/mL has the satisfaction of the analgesic effect,safe and less adverse reactions,etc.It is worthy of promotion.