中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2008年
11期
13-15
,共3页
酰胺类%前列腺切除术%镇痛,病人控制%镇痛,硬膜外%疼痛,手术后
酰胺類%前列腺切除術%鎮痛,病人控製%鎮痛,硬膜外%疼痛,手術後
선알류%전렬선절제술%진통,병인공제%진통,경막외%동통,수술후
Amides%Prostatectomy%Analgesia,patient - controlled%Analgesia,epidural%Pain,postoperation
目的 观察不同浓度罗哌卡因混合舒芬太尼病人自控硬膜外镇痛(PCEA)用于经耻骨上前列腺切除术(SPP)后的效果.方法 SPP病人60例,ASA Ⅰ或Ⅲ级,随机分为3组:0.12%罗哌卡因混合舒芬太尼PCEA组(RL组)、0.2%罗哌卡因混合舒芬太尼PCEA组(RH组)和舒芬太尼病人自控静脉镇痛(PCIA)组(S组),每组20例.记录术后第6、24、48、72 h(T6、T24、T48和T72)运动神经阻滞程度评分(Bromage评分);记录术后即刻～6 h、术后6～24 h、术后24～48 h和术后48～72 h时段膀胱痉挛次数;采用视觉模拟评分法(VAS)记录病人膀胱痉挛时和非痉挛时疼痛程度;记录有关的副作用及术后72 h膀胱冲洗液内红细胞的总数.结果 ①T6时Bromage评分RL组和RH组高于S组(P<0.05或0.01),T24～72时RH组高于RL组和S组(P<0.01),RL组与S组之间差异无统计学意义.②膀胱痉挛次数在术后6 h内三组差异无统计学意义,术后6～72 h,RL组和RH组低于S组(P<0.05),其中术后6～24 h RH组少于RL组(P<0.05),术后24～72 h,RH组和RL组之间差异无统计学意义.③在膀胱痉挛时,VAS评分RH组和RL组低于S组(P<0.05),RH组和RL组差异无统计意义.在非膀胱痉挛时,三组之间差异无统计学意义.④RL组和RH组术后72 h膀胱冲洗液内红细胞总数低于S组(P<0.01),RL组与RH组差异无统计学意义.结论 与舒芬太尼PCIA相比,SPP后使用0.12%或0.2%的罗哌卡因混合舒芬太尼进行PCEA,能更有效地减少膀胱痉挛,减少前列腺窝创面的出血量.SPP后不同时段采用不同浓度的罗哌卡因混合舒芬太尼进行PCEA,效果更好.舒芬太尼镇痛效果好,安全性高.
目的 觀察不同濃度囉哌卡因混閤舒芬太尼病人自控硬膜外鎮痛(PCEA)用于經恥骨上前列腺切除術(SPP)後的效果.方法 SPP病人60例,ASA Ⅰ或Ⅲ級,隨機分為3組:0.12%囉哌卡因混閤舒芬太尼PCEA組(RL組)、0.2%囉哌卡因混閤舒芬太尼PCEA組(RH組)和舒芬太尼病人自控靜脈鎮痛(PCIA)組(S組),每組20例.記錄術後第6、24、48、72 h(T6、T24、T48和T72)運動神經阻滯程度評分(Bromage評分);記錄術後即刻～6 h、術後6～24 h、術後24～48 h和術後48～72 h時段膀胱痙攣次數;採用視覺模擬評分法(VAS)記錄病人膀胱痙攣時和非痙攣時疼痛程度;記錄有關的副作用及術後72 h膀胱遲洗液內紅細胞的總數.結果 ①T6時Bromage評分RL組和RH組高于S組(P<0.05或0.01),T24～72時RH組高于RL組和S組(P<0.01),RL組與S組之間差異無統計學意義.②膀胱痙攣次數在術後6 h內三組差異無統計學意義,術後6～72 h,RL組和RH組低于S組(P<0.05),其中術後6～24 h RH組少于RL組(P<0.05),術後24～72 h,RH組和RL組之間差異無統計學意義.③在膀胱痙攣時,VAS評分RH組和RL組低于S組(P<0.05),RH組和RL組差異無統計意義.在非膀胱痙攣時,三組之間差異無統計學意義.④RL組和RH組術後72 h膀胱遲洗液內紅細胞總數低于S組(P<0.01),RL組與RH組差異無統計學意義.結論 與舒芬太尼PCIA相比,SPP後使用0.12%或0.2%的囉哌卡因混閤舒芬太尼進行PCEA,能更有效地減少膀胱痙攣,減少前列腺窩創麵的齣血量.SPP後不同時段採用不同濃度的囉哌卡因混閤舒芬太尼進行PCEA,效果更好.舒芬太尼鎮痛效果好,安全性高.
목적 관찰불동농도라고잡인혼합서분태니병인자공경막외진통(PCEA)용우경치골상전렬선절제술(SPP)후적효과.방법 SPP병인60례,ASA Ⅰ혹Ⅲ급,수궤분위3조:0.12%라고잡인혼합서분태니PCEA조(RL조)、0.2%라고잡인혼합서분태니PCEA조(RH조)화서분태니병인자공정맥진통(PCIA)조(S조),매조20례.기록술후제6、24、48、72 h(T6、T24、T48화T72)운동신경조체정도평분(Bromage평분);기록술후즉각～6 h、술후6～24 h、술후24～48 h화술후48～72 h시단방광경련차수;채용시각모의평분법(VAS)기록병인방광경련시화비경련시동통정도;기록유관적부작용급술후72 h방광충세액내홍세포적총수.결과 ①T6시Bromage평분RL조화RH조고우S조(P<0.05혹0.01),T24～72시RH조고우RL조화S조(P<0.01),RL조여S조지간차이무통계학의의.②방광경련차수재술후6 h내삼조차이무통계학의의,술후6～72 h,RL조화RH조저우S조(P<0.05),기중술후6～24 h RH조소우RL조(P<0.05),술후24～72 h,RH조화RL조지간차이무통계학의의.③재방광경련시,VAS평분RH조화RL조저우S조(P<0.05),RH조화RL조차이무통계의의.재비방광경련시,삼조지간차이무통계학의의.④RL조화RH조술후72 h방광충세액내홍세포총수저우S조(P<0.01),RL조여RH조차이무통계학의의.결론 여서분태니PCIA상비,SPP후사용0.12%혹0.2%적라고잡인혼합서분태니진행PCEA,능경유효지감소방광경련,감소전렬선와창면적출혈량.SPP후불동시단채용불동농도적라고잡인혼합서분태니진행PCEA,효과경호.서분태니진통효과호,안전성고.
Objective To investigate the efficacy of patient- controlled epidural analgesia (PCEA) with ropivacaine plus sufentanil for postoperative analgesia after prostatectomy. Methods Sixty ASA Ⅱ or Ⅲ patients aged 62 - 78 years weighing 52 - 84 kg undergoing prostatectomy were randomly divided into 3 groups with 20 patients in each group: group Ⅰ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml. Group Ⅱ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml and group Ⅲ received patient-controlled intravenous analgesia (PCIA) with sufentanil 1 μg/ml. Postoperative pain was assessed using VAS (0 = no pain, 10 = worst pain). The degree of motor blockade (modified bromage scale) was evaluated at 6, 24, 48 and 72 h after operation( T1～4). Bladder spasm episodes were recorded. Side effects including nausea, vomiting and pruritus and the total number of RBC in rinse solution were also recorded. Results ①Bromage score(0 = no motor block,3 = inability to flex ankle joint)was significantly higher in group Ⅰ and Ⅱ than in group Ⅲ at T1 (6 h after op. ), but ingnificantly lower in group Ⅰ and Ⅲ than in group Ⅱ at T2-4 (24 - 72 h after operation). ②VAS score(0 = no pain, 10 = worst pain)was not significantly different among the 3 groups without bladder spasm but significantly higher in group Ⅲ than in other 2 groups during episodes of bladder spasm. ③The number of bladder spasm episodes was not significantly different among the 3 groups with in 6h after operation, but was significant larger in group Ⅲ than in the other two groups during 6 -72 h after operation. During 6 -24 h after operation more bladder spasm attacks occurred in group Ⅰ than in group Ⅱ. ④The incidence of side effects was significantly lower and the total number of RBC in rinse solution was significantly smaller in group Ⅰ and Ⅱ than in group Ⅲ. Conclusion PCEA with 0.12% or 0.2% ropivacaine plus sufentanil can effectively reduce the number of bladder spasm attack and postoperative bladder bleeding. Different concentrations of ropivacaine should be used for PCEA during different postoperative periods.
