氢吗啡酮联合罗哌卡因用于妇科术后自控硬膜外镇痛

发布时间：2018-08-05 10:27

【摘要】：目的探讨氢吗啡酮联合罗哌卡因用于妇科术后自控硬膜外镇痛(PCEA)的可行性以及不良反应。方法 120例妇科经硬膜外麻醉行手术治疗且要求术后镇痛的患者,随机分为三组,每组40例。三组手术、麻醉方法相同,均在手术结束时行PCEA治疗。镇痛液配方:H组氢吗啡酮4μg·m L-1,HR组氢吗啡酮4μg·m L-1+罗哌卡因1 mg·m L-1,MR组吗啡40μg·m L-1+罗哌卡因1 mg·m L-1组。评价术毕2 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、36 h(T6)、48 h(T7)时患者静态、动态疼痛视觉模拟量表评分(VAS)和Ramsay镇静评分,记录自控按压次数及不良反应的发生情况。结果 T1~T4时H组患者静态疼痛VAS高于HR组和MR组(P0.05),HR组与MR组各时间点静态疼痛VAS比较差异均无显著意义(P0.05);三组术后各观察时点动态VAS和Ramsay镇静评分比较差异均无显著意义(P0.05)。H组患者自控按压次数多于HR组和MR组(P0.05),后两组无显著差异(P0.05)。MR组瘙痒、恶心、呕吐发生率均高于其他两组,且术后肛门首次排气时间延长(P0.05),H组与HR组间无显著差异(P0.05)。结论氢吗啡酮联合罗哌卡因用于妇科术后PCEA能获得更为满意的镇痛效果,且不良反应少。
[Abstract]:Objective to investigate the feasibility and adverse effects of hydromorphine combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after gynecological surgery. Methods 120 gynecological patients undergoing epidural anesthesia and requiring postoperative analgesia were randomly divided into three groups (40 cases in each group). All three groups were treated with PCEA at the end of operation. 4 渭 g / ml ropivacaine 1 渭 g / mL ropivacaine, 4 渭 g / ml ropivacaine, 4 渭 g / mL ropivacaine, 40 渭 g / m ~ (-1) ropivacaine 1 mg / m ~ (-1) in HR group. To evaluate the static and dynamic pain visual analogue scale scores (VAS) and Ramsay sedation score) at 2 h (T 1) 4 h (T 2) 8 h (T 3) 12 h (T 4) 24 h (T 5) and 36 h (T 6) and 48 h (T 7) after operation, and to record the times of self-controlled compression and the occurrence of adverse reactions. Results there was no significant difference in static pain VAS between HR group and Mr group (P0.05), and there was no significant difference in dynamic VAS and Ramsay sedation score between three groups at different time points after T1~T4 (P 0.05), but there was no significant difference in static pain VAS between HR group and Mr group at different time points after T1~T4 (P0.05), and there was no significant difference in dynamic VAS and Ramsay sedation score between HR group and Mr group (P0.05). The times of self-controlled compression in H group were more than those in HR group and Mr group (P0.05), but there was no significant difference between the latter two groups (P0.05). The incidence of nausea and vomiting was higher than that of the other two groups, and the first time of anal exhaust was prolonged after operation (P0.05). There was no significant difference between H group and HR group (P0.05). Conclusion Hydromorphone combined with ropivacaine can obtain more satisfactory analgesic effect and less adverse reaction after gynecological operation with ropivacaine.
【作者单位】：武汉大学人民医院麻醉科;
【分类号】：R614

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