罗哌卡因复合芬太尼用于乳腺癌术后硬膜外自控镇痛的临床观察

 目的 观察不同浓度罗哌卡因复合芬太尼用于乳腺癌根治术后硬膜外腔自控镇痛(patient controlled epidural analgesia,PCEA)，比较其镇痛、镇静效果及较小安全有效浓度。方法 选择拟行乳腺癌根治手术患者75例，随机分为三组，每组25例。Ⅰ组：0.10%罗哌卡因+3 μg/ml芬太尼+0.10 mg/ml咪唑安定+0.10 mg/ml托烷司琼；Ⅱ组：0.125%罗哌卡因+3 μg/ml芬太尼+0.10 mg/ml+咪唑安定+0.10 μg/ml托烷司琼；Ⅲ组：0.15%罗哌卡因+3 μg/ml芬太尼+0.10 mg/ml咪唑安定+0.10 mg/ml托烷司琼，各组均加0.9%氯化钠溶液至100 ml，再行PCEA。监测患者镇痛开始后6、12、24、48 h各时点心率、平均动脉血压、呼吸频率、脉搏、血氧饱和度，VAS评分、Ramesay评分、Bro-mage评级；并记录镇静、镇痛满意度和不良反应。结果 各组VAS均值小于3分；各组病人镇痛期间各时点心率、平均动脉压、呼吸频率差异有统计学意义（P<0.05）；各组不同时点VAS评分、Bromage评级、Ramesay评分差异有统计学意义(P<0.05），各组间同一时点比较差异无统计学意义（Pvas=0.154, Pramesay=0.470），Ⅰ、Ⅱ与Ⅲ组的Bromage比较差异有统计学意义（P=0.013）。结论 三组不同浓度的罗哌卡因复合芬太尼用于乳腺癌术后硬膜外腔自控镇痛都是安全有效的；镇痛、镇静效果较好。0.10%罗哌卡因组运动阻滞发生率低，不良反应相对较少，0.10%罗哌卡因可能是最佳有效浓度。

Effects of Ropivacaine Combined with Fentanyl on Breast Cancer Patient's Self-controlled Epidural Analgesia after Operation

Abstract:Objective To investigate the effects and the minimal effective concentrations of ropivacaine combined with fentanyl on the patients controlled epidural analgesia (PCEA) after breast cancer operation. Methods Seventy-five ASA (American statistical association)Ⅰ~Ⅲ patients of breast cancer undergoing operations were randomly divided into three groups (n=25 in each group). Ropivacaine in different concentration combined with fentanyl was used in each group. Group Ⅰ：0.1% ropivacaine +3 μg/ml fentanyl+0.10 mg/ml mizalamine+0.10 mg/ml tropisetrone; Group Ⅱ：0.125% ropivacaine+3 μg/ml fentanyl+0.10 mg/ml mizalamine+0.10 mg/ml tropisetrone; Group Ⅲ：0.15% ropivacaine +3 μg/ml fentanyl+0.10 mg/ml mizalamine+0.10 mg/ml tropisetrone+ 0.9%N·S to 100 ml. All patients received patient controlled epidural analgesia(PCEA). Heart rate, mean artery pressure, respiration rate, and SpO2 were monitored at 6, 12, 24 and 48h after analgesia. VAS,Ramesay score,Bromage greade, sedative score，satisfaction of analgesia and side effects were also recorded. Results Average VAS score in group Ⅰ,Ⅱ and Ⅲ was all below 3.There were significant difference in heart rate, mean atery pressure, respiration rate at 6,12,24 and 48h（P<0.05). There were significant difference in VAS,Bromage,Ramesay at different time point（P<0.05). There were no significant difference in three groups (Pvas=0.154, Pramesay=0.470),while there were significant difference in groupⅢcompared to groupⅠ,Ⅱ in Bromage(P＝0.013, P<0.05). Conclusion Different concentrations of ropivacaine combined with fentanyl provide the optimum balance between pain relief and side effects in postoperative radical mastectomy of breast cancer, 0.10% ropivacaine combined with fentanyl might be lower in the rate of complication and which should be the minimal effective concentration.