丁丙诺啡与氯胺酮应用于术后硬膜外镇痛的临床比较

目的:比较丁丙诺啡与氯胺酮应用于硬膜外腔自控镇痛(PCEA)的镇痛效果与不良反应。方法:选择腰硬联合麻醉下行下腹部择期手术和符合美国麻醉医师协会分级Ⅰ～Ⅱ级的患者60例。随机双盲分为A、B、C组,分别为丁丙诺啡+氟哌利多、丁丙诺啡+氟哌利多+布比卡因、氯胺酮+氟哌利多+布比卡因。观察0～48h内各时段追加次数、视觉模拟评分(VAS)、镇静评分(Ramsay评分)、肠功能恢复时间及恶心、呕吐等不良反应。结果:各时段追加次数、VAS、Ramsay评分,A组与B、C组比较差异有统计学意义(P<0.05);肠功能恢复时间,A组与B、C组比较差异有统计学意义(P<0.05);恶心、呕吐、皮肤瘙痒、尿潴留发生率各组间比较差异均有统计学意义(P<0.01)。结论:丁丙诺啡、氯胺酮复合局麻药行PCEA的镇痛效果确切;C组在降低恶心、呕吐、皮肤瘙痒、尿潴留发生率方面显示明显优越性。

Buprenorphine VS. Ketamine for Postoperative Epidural Analgesia

OBJECTIVE： To evaluate the postoperative analgesic effects and side effects of buprenorphine versus ketamine for patients with patient- controlled epidural analgesia （PCEA）. METHODS： 60 patients with Ⅰ - Ⅱ grade in physical status evaluated by American society of anesthesiologists （ASA） scheduled for lower abdomen surgery by lumbar anesthesia combined epidural anesthesia were divided into three groups by a randomized double blind method to be treated with Buprenorphine ＋ Droperidol （Group A）, Buprenorphine ＋ Droperidol ＋ Bupivacaine （Group B）, or Ketamine ＋ Droperidol＋ Bupivacaine （Group C）. The visual analogous scale （VAS）, Ramsay scale, frequency to press the analgesia pump was recorded at 0-48 h after operation, the time spent for the recovery of intestinal functions; score for nausea vomiting and other adverse drug reactions were observed. RESULTS： Frequency to press the analgesia pump, VAS score and Ramsay score in Group A in different period of time were all significantly different from those in Group B and Group C （P 〈 0.05） ; in terms of the time spent for the recovery of intestinal function, there were significant difference between Group A and the other two groups （Group B and Group C） （P 〈 0.05） ; there were significant differences among the three groups in incidence of nausea, skin pruritus and urine retention （P 〈 0.01） . CONCLUSION： Combined local anethesia with buprenorphine and ketamine showed proved efficacy for patients undergoing PCEA; and ketamine was more effective in decreasing the incidences of nausea and vomiting and skin pruritus.