摘要
目的观察地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛的临床效果和不良反应。方法美国麻醉医师协会（ASA）I、Ⅱ级择期经腹子宫全切除术患者60例，按随机数字表分为两组，每组30例。地佐辛组给予地佐辛6mg＋0．75％盐酸罗哌卡因20ml＋生理盐水稀释至100ml；吗啡组给予吗啡6mg＋0．75％盐酸罗哌卡因20ml＋生理盐水稀释至100ml，进行硬膜外术后镇痛。负荷剂量：地佐辛组为地佐辛2mg＋生理盐水稀释至5ml；吗啡组为吗啡2mg＋生理盐水稀释至5ml；持续剂量2ml／h，单次给药剂量2ml，锁定时间15min。全程镇痛48h。采用视觉模拟评分法（VAS）评价术后不同时间点（4、8、12、24、36、48h）的镇痛效果，并记录硬膜外术后镇痛中的不良反应。结果两组患者镇痛效果总体满意，地佐辛组术后不同时间点VAS评分略低于吗啡组，术后不同时间点（4、8、12、24、36、48h）VAS评分比较，地佐辛组[（2．7±0．4）、（2．5±0．6）、（2．2±0．5）、（1．5±0．5）、（1．3±0．5）、（1．1．4-0．3）分]略低于吗啡组[（2．8±0．5）、（2．6±0．7）、（2．3±0．6）、（1．6±0．7）、（1．5±0．6）、（1．2±0．4）分]，但差异均无统计学意义（F组内=2414．96，P〈0．01；F组间=0．63，P〉0．05；F交互=2．42，P〉0．05）；两组术后各时间点VAS评分比较，差异无统计学意义（P均〉0．05）；组内术后12、24、36、48h与术后4h时间点比较差异有统计学意义（P均〈0．01）。地佐辛组恶心、呕吐及皮肤瘙痒的发生率[（3．3％（1／30）、0（0／30）]均低于吗啡组[26．7％（8／30）、20．0％（6／30）]，两组比较差异有统计学意义（P值分别为0．026、0．024）。结论地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛安全有效、不良反应少，值得在临床中推广使用。
Objective To investigate the postoperative epidural analgesia and adverse reactions in total abdominal hysterectomy with dezocine and ropivacaine. Methods Sixty elective transabdominal hysterectomy patients with American Society of Anesthesiologists （ASA） I - 11 grade were randomly divided into two groups, dezocine group and morphine group, there were 30 eases in each group. Dezocine group ： dezocine （ 6 mg） ＋ 0. 75% ropivacaine hydrochloride（20 ml） ＋ saline dilution, diluted to 100 ml. Morphine group ： morphine （6 mg） ＋ 0. 75% hydroehloride ropivaeaine（ 20 ml） ＋ saline dilution, diluted to 100 ml, for postoperative epidural analgesia. Both two groups were adopted in LCP mode with a loading dose： dezocine group, dezocine（2 mg） ＋ saline dilution, diluted to 5 ml ; morphine group, morphine （ 2 mg） ＋ saline dilution, diluted to 5 ml. Continuous infusion of 2 ml/h,a bolus dose of 2 ml,and a lockout interval of 15 min. The analgesia duration was 48 h. Visual analogue scales （VAS） evaluation was employed to assess the analgesic effect, and the postoperative epidural analgesia adverse reaction were a/so recorded. Results The analgesic effect was both satisfied in the two groups. Comparing the VAS scores postoperative at different time point （4 h, 8 h, 12 h, 24 h, 36 h, 48 h） , dezoeine group（2. 7 ± 0. 4,2. 5 ± 0. 6,2. 2 ± 0. 5,1.5 ± 0. 5,1.3 ± 0. 5,1.1 ± 0. 3 ） were slightly lower than morphine group （2. 8 ± 0. 5,2. 6 ± 0.7,2. 3±0. 6,1.6 ± 0.7,1.5 ± 0. 6,1.2 ± 0.4 ）, but the difference was not significant （ within the group ： F = 2414. 96, P 〈 0. 01 ; between the group ： F = 0. 63, P 〉 0.05 ; interactive ： F = 2.42 ,P 〉0. 05 ）. Comparison of VAS scores at different time points after operation in two groups, the difference was not statistically significant;And within the group, there was not ,the difference was not significant at the time point at 12,24,36,48 h compare to postoperative at 4 h（P 〈0.01）. the Adverse reaction like nausea and vomiting, skin itching occur rate is lower in dezocine group （ 3.3% （ 1/30 ） ,0 （ 0/30 ） ） than that of in morphine group（26. 7% （8/30）, 20. 0% （6/30））, and there were signficant differences between the two groups （P = 0. 026,0. 024,P 〈 0.05 ） . Conclusion Dezocine composed with ropivacaine is safe and effective, and with few adverse reactions in total abdominal hysterectomy postoperative epidural analgesia, it is worth of widely use in clinical.
出处
《中国综合临床》
2013年第7期751-754,共4页
Clinical Medicine of China
