妇科手术后罗哌卡因吗啡不同模式硬膜外病人自控镇痛对药效学的影.docVIP

???? 妇科手术后罗哌卡因?吗啡不同模式硬膜外病人?自控镇痛对药效学的影响 ???? ???? 【摘　要】　目的　比较研究妇科手术后罗哌卡因(Rop)、吗啡(Mor)不同模式病人自控硬膜外镇痛(PCEA)的效应。方法　选择经腹子宫全切术的病人60例(ASA Ⅰ～Ⅱ级)，随机分成三组，均选双泵法。A泵镇痛液为0.2%Rop，B泵镇痛液为0.01%Mor；Ⅰ组：A泵给药方法为每小时2ml持续硬膜外输注，B泵以LP模式PCEA；Ⅱ组：A泵输注方法同Ⅰ组A泵，B泵以LCP模式PCEA；Ⅲ组：A泵输注为零，B泵给药方法同Ⅱ组B泵。结果　三组镇痛效果相似，而24h硬膜外Rop药量Ⅱ组Ⅰ组Ⅲ组，PCEA所需的Mor剂量Ⅰ组最少。从4h后PCA按压次数Ⅰ组Ⅱ组≈Ⅲ组(P0.05)，术后2h无运动阻滞的病人Ⅰ组为40%,Ⅱ组为45%，Ⅲ组为76%，术后4h三组病人均无运动阻滞。不良反应：三组病人恶心呕吐发生率为5%～10%，无呼吸抑制。结论　Rop持续硬膜外输注时，吗啡PCEA以LP模式用药，在达到满意镇痛效应的情况下，能减少吗啡的消耗量，手术后4h对病人无运动神经阻滞作用。【关键词】　镇痛　硬膜外　病人自控　罗哌卡因　吗啡 The effects of different mode of ropivacaine and morphine on patient-controlled epidural analgesia for postoperative pain relief after gynecologic surgery She Shouzhang，Kang Jiali，Liu Jiyun（Dept.of Anesthesiology,Guangzhou Medical College Affiliated First Peoples Hopital,Guangzhou,510180） 【Abstract】　Objective　The effects of 0.2% ropivacaine continuous infusion and 0.01% morphine with epidural patient-controlledl analgesia(PCA)for postoperative pain relief were compared after total hysterectomy.Methods　60 adult patients(ASA grade Ⅰ～Ⅱ)undergoing total hysterectomy were randomly divided into three groups,each group was performed analgesia by two pumps:group Ⅰ(n=20)with 0.2% ropivacaine-2ml/h epidural continuous infusion by Graseby 3300 pump;group Ⅱ (n=20)with 0.2% ropivacaine-2ml/h epidural continuous infusion and 0.01% morphine epidural PCA with loading dose 5ml and continuous infusion 0.5ml/h and dolus 1ml(LCP);group Ⅲ(n=20)without 0.2% ropivacaine epidural continuous infusion but 0.01% morphine epidural PCA with LCP.Results　The analgesic efficacy in the three groups was similar.The group Ⅰ needed less morphine of epidural PCA over 24 hours than that in the group ⅡandⅢ.45% patients in the group Ⅰ and 40% patients in the group Ⅱ compared with 76% in the group Ⅲ had no motor block 2h after operation.The incidence of nausea and vomiting was between 5% to 10%,and no respiratory depression in three groups.Conclusion　Adding low dose 0.2% ropivacaine epidural continu