CAJ | 학술논문

目的：观察不同浓度罗哌卡因复合布托啡诺硬膜外阻滞应用于剖宫产镇痛效果及安全性,探讨罗哌卡因的最佳浓度。方法：128例行剖宫产术患者随机分为三组,均采用硬膜外阻滞,Ⅰ组(42例)、Ⅱ组(43例)和Ⅲ组(43例)。分别给予0.075%、0.10%和0.125%罗哌卡因复合0.004%布托啡诺行硬膜外自控镇痛(PECA)。结果：Ⅱ组、Ⅲ组感觉阻滞起效时间和痛觉消失时间显著短于Ⅰ组,(P<0.05),Ⅱ组和Ⅲ组比较无显著性差异(P>0.05)；Ⅰ组和Ⅱ组运动阻滞起效时间与时效及运动阻滞程度明显高于Ⅲ组(P<0.05),而Ⅰ组和Ⅱ组比较无显著性差异(P>0.05)；Ⅱ组和Ⅲ组PECA按压次数和用药总量显著低于Ⅰ组以及术后2h、12h VAS评分值显著低于Ⅰ组(P<0.05),而Ⅱ组、Ⅲ组之间无显著性差异(P>0.05),三组术后24h VAS评分值比较无显著性差异(P>0.05)；Ⅰ组和Ⅱ组恶心呕吐、皮肤瘙痒及嗜睡等不良反应发生率均显著低于Ⅲ组(P<0.05)。结论：剖宫产术硬膜外阻滞中采用0.10%罗哌卡因联合0.004%布托啡诺可获得理想镇痛效果,不良反应少。
목적：관찰불동농도라고잡인복합포탁배낙경막외조체응용우부궁산진통효과급안전성,탐토라고잡인적최가농도。방법：128례행부궁산술환자수궤분위삼조,균채용경막외조체,Ⅰ조(42례)、Ⅱ조(43례)화Ⅲ조(43례)。분별급여0.075%、0.10%화0.125%라고잡인복합0.004%포탁배낙행경막외자공진통(PECA)。결과：Ⅱ조、Ⅲ조감각조체기효시간화통각소실시간현저단우Ⅰ조,(P<0.05),Ⅱ조화Ⅲ조비교무현저성차이(P>0.05)；Ⅰ조화Ⅱ조운동조체기효시간여시효급운동조체정도명현고우Ⅲ조(P<0.05),이Ⅰ조화Ⅱ조비교무현저성차이(P>0.05)；Ⅱ조화Ⅲ조PECA안압차수화용약총량현저저우Ⅰ조이급술후2h、12h VAS평분치현저저우Ⅰ조(P<0.05),이Ⅱ조、Ⅲ조지간무현저성차이(P>0.05),삼조술후24h VAS평분치비교무현저성차이(P>0.05)；Ⅰ조화Ⅱ조악심구토、피부소양급기수등불량반응발생솔균현저저우Ⅲ조(P<0.05)。결론：부궁산술경막외조체중채용0.10%라고잡인연합0.004%포탁배낙가획득이상진통효과,불량반응소。
Objective:To observe the clinical effect and safety of different concentration of ropivacaine in ropivacaine combined with butophanol in epidural anesthesia for cesarean section,and to identify the optimal concentration of ropivacaine.Methods:128 patients for cesarean section were randomly divided into three groups.All the patients were performed by epidural anesthesia,GroupⅠ(n=42),Group Ⅱ (n=43) and Group Ⅲ (n=43) was given 0.004% butophanol combined with 0.075%,0.10%, 0.125% ropivacaine separately.Results:The onset time of sense block,disappeared time of pain in GroupⅡand GroupⅢwere significantly shorter than those in GroupⅠ(P<0.05),while there was not significantly different betweenⅡgroup andⅢgroup (P>0.05).Compared with GroupⅠand GroupⅡ,the onset time, duration and degree of motor block in GroupⅢwas significantly longer,while there was not significantly different between GroupⅠand GroupⅡ(P>0.05).The pressing numbers of PECA,total dosage and VAS scores after cesarean section for 2h,12h in GroupⅡand GroupⅢwere significantly lower than that in GroupⅠ(P<0.05),while there was no significantly difference between GroupⅡand GroupⅢ(P>0.05).The VAS scores after cesarean section for 24 h among three groups were not statistically different (P<0.05).The rate of side effect including nausea and vomiting,sleepiness and itchy skin in GroupⅠand GroupⅡwas significantly lower than that in GroupⅢ(P<0.05).Conclusion:The concentration of 0.10%ropivacaine+0.004%butophanol in epidural anesthesia for cesarean section can contribute to provide good effect of analgesia, and can reduce the side effect.