罗哌卡因伍用哌替啶、吗啡或曲马多用于术后硬膜外自控镇痛效果的比较

目的对比观察罗哌卡因伍用哌替啶、吗啡或曲马多用于术后硬膜外自控镇痛(PCEA)的效果及不良反应。方法选择ASAⅠ～Ⅱ级择期行下腹部或下肢手术的患者90例,随机分为罗哌卡因复合哌替啶(A组)、复合吗啡(B组)和复合曲马多(C组),各30例,分别于用药后4、8、24和48h观察血压、心率、脉搏血氧(SpO2)、疼痛视觉模拟评分(VAS)、Ramsay镇静评分及不良反应。结果A组镇痛效果明显优于B组和C组(P<0.05),B组、C组镇痛效果差异无统计学意义(P>0.05)。C组Ramsay镇静评分明显大于A组、B组(P<0.05)。三组患者均无明显的呼吸抑制,B组有3例发生瘙痒,C组53%的患者出现多汗;三组患者恶心的发生率分别为5.6%、51.0%和54.3%,呕吐的发生率分别为9.0%、54.6%、57.6%。结论罗哌卡因复合哌替啶用于术后PCEA的效果优于罗哌卡因复合吗啡或曲马多,而且不良反应少,是一种能获得平衡镇痛的较好方法。

Combination of ropivacaine with pethidine,morphine or tramadol for postoperative PCEA

Objective To compare the analgesic effects and adverse effects of ropivacaine combined with pethidine,morphine or tramadol for postoperative patient control epidural analgesia(PCEA).Methods90 ASA Ⅰ~Ⅱ patients scheduled for elective abdominal or legs surgeries were randomly divided into 3 groups.Group A(30 cases):ropivacaine 200 mg+ pethidine 50 mg+ ondansetron 4 mg;Group B(30 cases):ropivacaine 200 mg+morphine 5 mg+ ondansetron 4 mg;Group C(cases):ropivacaine 200mg+ tramadol 600 mg+ ondansetron 4 mg.The VAS,Ramsay sedation scores,HR,BP,SpO2 and adverse effects were observed at 4 th,8 th,24 th,48 th hour after operation.ResultsVAS in group A was lower than those in group B and group C(P<0.05),and there was no significant difference in VAS between group B and group C(P>0.05).Ramsay sedation scores of group C were higher than those of group A and group B(P<0.05).There was no respiratory arrest in 3 groups.Incidences of nausea,vomiting in group A were lower than those in group B and C.ConclusionRopivacaine combined with pethidine for postoperative PCEA has a better analgesic effect than ropivacaine combined with morphine or tramadol.