不同浓度吗啡硬膜外镇痛在TUVP术后的应用

目的评价不同浓度吗啡在经尿道前列腺汽化电切(transurethral vaporesection of prostate,TUVP)术后硬膜外镇痛的效果。方法择期行TUVP术的患者40例,无神经系统、哮喘等疾病,无硬膜外麻醉禁忌症,手术时间60min内,随机分为两组,分别在术后予硬膜外10 mg盐酸吗啡注射液 0.2%盐酸罗哌卡因注射液共100 ml镇痛(A组)、4 mg盐酸吗啡注射液 0.2%盐酸罗哌卡因注射液共100 ml镇痛(B组),比较生命体征、不良反应、镇痛效果等情况。结果两组患者在年龄、性别、基础疾病、麻醉手术方法和切除前列腺重量上无统计学差异,且术后循环均稳定,A组的恶心、呕吐、皮肤瘙痒等不良反应发生率略高于B组,但差异无统计学意义(P>0.05),但A组膀胱痉挛性疼痛发生率明显低于B组(P<0.05),继发性出血少。结论10 mg盐酸吗啡注射液 0.2%盐酸罗哌卡因注射液共100 ml持续硬膜外镇痛,可以有效缓解TUVP术后膀胱阵发性痉挛疼痛。

Comparison of different concentration of morphine on epidural analgesia after TUVP

Objective To compare the effect of different concentrations of morphine on epidural analgesia after transurethral vaporesection of prostate(TUVP) operation.Methods Forty cases who had selective TUVP operation within 60 minutes,without nervous system disease,nor asthma or other contraindications for epidural punctura were randomly divided into two groups: group A with 10 mg morphine 0.2% ropivacaine 100 ml totally for postoperative continue epidural analgesia(PCEA) and group B with 4 mg morphine 0.2% ropivacaine100 ml totally for PCEA.Vital signs,adverse reactions,anesthesia effects were observed in these two groups.Results There were no statistical differences in patients' age,sex,underlying diseases,method of analgesia operation and the weight of cut prostate between two groups.All the patients had stable circulation condition after operation.Patients with adverse reactions like nausea,emesis and itch of skin were a little more in group A,but there were no significant differences compared with those in group B(P>0.05).Rate of spasm pain of the urinary bladder and postoperative massive bleeding were less in group A than in group B(P<0.05).Conclusion Postoperative continue epidural analgesia with 10 mg morphine 0.2% ropivacaine can effectively reduce the occurrence of urinary bladder spasm pain.