中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
7期
751-754
,共4页
卢增停%林霭婷%曾丽蓉%何绮桃
盧增停%林靄婷%曾麗蓉%何綺桃
로증정%림애정%증려용%하기도
硬膜外镇痛%经腹子宫全切除术%地佐辛%罗哌卡因%吗啡
硬膜外鎮痛%經腹子宮全切除術%地佐辛%囉哌卡因%嗎啡
경막외진통%경복자궁전절제술%지좌신%라고잡인%마배
Epidural analgesia%Abdominal hysterectomy%Dezocine%Ropivacaine%Morphine
目的 观察地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛的临床效果和不良反应.方法 美国麻醉医师协会(ASA)Ⅰ、Ⅱ级择期经腹子宫全切除术患者60例,按随机数字表分为两组,每组30例.地佐辛组给予地佐辛6 mg +0.75％盐酸罗哌卡因20 ml+生理盐水稀释至100 ml;吗啡组给予吗啡6 mg +0.75％盐酸罗哌卡因20ml+生理盐水稀释至100 ml,进行硬膜外术后镇痛.负荷剂量:地佐辛组为地佐辛2 mg+生理盐水稀释至5ml;吗啡组为吗啡2 mg+生理盐水稀释至5ml;持续剂量2 ml/h,单次给药剂量2ml,锁定时间15 min.全程镇痛48 h.采用视觉模拟评分法(VAS)评价术后不同时间点(4、8、12、24、36、48 h)的镇痛效果,并记录硬膜外术后镇痛中的不良反应.结果 两组患者镇痛效果总体满意,地佐辛组术后不同时间点VAS评分略低于吗啡组,术后不同时间点(4、8、12、24、36、48 h)VAS评分比较,地佐辛组[(2.7±0.4)、(2.5±0.6)、(2.2±0.5)、(1.5±0.5)、(1.3±0.5)、(1.1±0.3)分]略低于吗啡组[(2.8±0.5)、(2.6±0.7)、(2.3±0.6)、(1.6±0.7)、(1.5±0.6)、(1.2±0.4)分],但差异均无统计学意义(F组内=2414.96,P＜0.01；F组间=0.63,P＞0.05；F交互=2.42,P＞0.05)；两组术后各时间点VAS评分比较,差异无统计学意义(P均＞0.05)；组内术后12、24、36、48 h与术后4h时间点比较差异有统计学意义(P均＜0.01).地佐辛组恶心、呕吐及皮肤瘙痒的发生率[(3.3％(1/30)、0(0/30)]均低于吗啡组[26.7％(8/30)、20.0％ (6/30)],两组比较差异有统计学意义(P值分别为0.026、0.024).结论 地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛安全有效、不良反应少,值得在临床中推广使用.
目的 觀察地佐辛複閤囉哌卡因用于經腹子宮全切除術後硬膜外鎮痛的臨床效果和不良反應.方法 美國痳醉醫師協會(ASA)Ⅰ、Ⅱ級擇期經腹子宮全切除術患者60例,按隨機數字錶分為兩組,每組30例.地佐辛組給予地佐辛6 mg +0.75％鹽痠囉哌卡因20 ml+生理鹽水稀釋至100 ml;嗎啡組給予嗎啡6 mg +0.75％鹽痠囉哌卡因20ml+生理鹽水稀釋至100 ml,進行硬膜外術後鎮痛.負荷劑量:地佐辛組為地佐辛2 mg+生理鹽水稀釋至5ml;嗎啡組為嗎啡2 mg+生理鹽水稀釋至5ml;持續劑量2 ml/h,單次給藥劑量2ml,鎖定時間15 min.全程鎮痛48 h.採用視覺模擬評分法(VAS)評價術後不同時間點(4、8、12、24、36、48 h)的鎮痛效果,併記錄硬膜外術後鎮痛中的不良反應.結果 兩組患者鎮痛效果總體滿意,地佐辛組術後不同時間點VAS評分略低于嗎啡組,術後不同時間點(4、8、12、24、36、48 h)VAS評分比較,地佐辛組[(2.7±0.4)、(2.5±0.6)、(2.2±0.5)、(1.5±0.5)、(1.3±0.5)、(1.1±0.3)分]略低于嗎啡組[(2.8±0.5)、(2.6±0.7)、(2.3±0.6)、(1.6±0.7)、(1.5±0.6)、(1.2±0.4)分],但差異均無統計學意義(F組內=2414.96,P＜0.01；F組間=0.63,P＞0.05；F交互=2.42,P＞0.05)；兩組術後各時間點VAS評分比較,差異無統計學意義(P均＞0.05)；組內術後12、24、36、48 h與術後4h時間點比較差異有統計學意義(P均＜0.01).地佐辛組噁心、嘔吐及皮膚瘙癢的髮生率[(3.3％(1/30)、0(0/30)]均低于嗎啡組[26.7％(8/30)、20.0％ (6/30)],兩組比較差異有統計學意義(P值分彆為0.026、0.024).結論 地佐辛複閤囉哌卡因用于經腹子宮全切除術後硬膜外鎮痛安全有效、不良反應少,值得在臨床中推廣使用.
목적 관찰지좌신복합라고잡인용우경복자궁전절제술후경막외진통적림상효과화불량반응.방법 미국마취의사협회(ASA)Ⅰ、Ⅱ급택기경복자궁전절제술환자60례,안수궤수자표분위량조,매조30례.지좌신조급여지좌신6 mg +0.75％염산라고잡인20 ml+생리염수희석지100 ml;마배조급여마배6 mg +0.75％염산라고잡인20ml+생리염수희석지100 ml,진행경막외술후진통.부하제량:지좌신조위지좌신2 mg+생리염수희석지5ml;마배조위마배2 mg+생리염수희석지5ml;지속제량2 ml/h,단차급약제량2ml,쇄정시간15 min.전정진통48 h.채용시각모의평분법(VAS)평개술후불동시간점(4、8、12、24、36、48 h)적진통효과,병기록경막외술후진통중적불량반응.결과 량조환자진통효과총체만의,지좌신조술후불동시간점VAS평분략저우마배조,술후불동시간점(4、8、12、24、36、48 h)VAS평분비교,지좌신조[(2.7±0.4)、(2.5±0.6)、(2.2±0.5)、(1.5±0.5)、(1.3±0.5)、(1.1±0.3)분]략저우마배조[(2.8±0.5)、(2.6±0.7)、(2.3±0.6)、(1.6±0.7)、(1.5±0.6)、(1.2±0.4)분],단차이균무통계학의의(F조내=2414.96,P＜0.01；F조간=0.63,P＞0.05；F교호=2.42,P＞0.05)；량조술후각시간점VAS평분비교,차이무통계학의의(P균＞0.05)；조내술후12、24、36、48 h여술후4h시간점비교차이유통계학의의(P균＜0.01).지좌신조악심、구토급피부소양적발생솔[(3.3％(1/30)、0(0/30)]균저우마배조[26.7％(8/30)、20.0％ (6/30)],량조비교차이유통계학의의(P치분별위0.026、0.024).결론 지좌신복합라고잡인용우경복자궁전절제술후경막외진통안전유효、불량반응소,치득재림상중추엄사용.
Objective To investigate the postoperative epidural analgesia and adverse reactions in total abdominal hysterectomy with dezocine and ropivacaine.Methods Sixty elective transabdominal hysterectomy patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ grade were randomly divided into two groups,dezocine group and morphine group,there were 30 cases in each group.Dezocine group:dezocine (6 mg) + 0.75％ ropivacaine hydrochloride(20 ml) + saline dilution,diluted to 100 ml.Morphine group:morphine(6 mg) + 0.75 ％ hydrochloride ropivacaine (20 ml) + saline dilution,diluted to 100 ml,for postoperative epidural analgesia.Both two groups were adopted in LCP mode with a loading dose:dezocine group,dezocine(2 mg) +saline dilution,diluted to 5 ml; morphine group,morphine (2 mg) + saline dilution,diluted to 5 ml.Continuous infusion of 2 ml/h,a bolus dose of 2 ml,and a lockout interval of 15 min.The analgesia duration was 48 h.Visual analogue scales (VAS) evaluation was employed to assess the analgesic effect,and the postoperative epidural analgesia adverse reaction were also recorded.Results The analgesic effect was both satisfied in the two groups.Comparing the VAS scores postoperative at different time point (4 h,8 h,12 h,24 h,36 h,48 h),dezocine group(2.7 ± 0.4,2.5 ± 0.6,2.2 ± 0.5,1.5 ± 0.5,1.3 ± 0.5,1.1 ± 0.3) were slightly lower than morphine group (2.8 ± 0.5,2.6 ± 0.7,2.3 ± 0.6,1.6 ± 0.7,1.5 ± 0.6,1.2 ± 0.4),but the difference was not significant (within the group:F =2414.96,P ＜ 0.01 ; between the group:F =0.63,P ＞ 0.05 ; interactive:F =2.42,P ＞0.05).Comparison of VAS scores at different time points after operation in two groups,the difference was not statistically significant; And within the group,there was not,the difference was not significant at the time point at 12,24,36,48 h compare to postoperative at 4 h (P ＜ 0.01).the Adverse reaction like nausea and vomiting,skin itching occur rate is lower in dezocine group (3.3 ％ (1/30),0 (0/30)) than that of in morphine group(26.7％ (8/30),20.0％ (6/30)),and there were signficant differences between the two groups (P =0.026,0.024,P ＜ 0.05).Conclusion Dezocine composed with ropivacaine is safe and effective,and with few adverse reactions in total abdominal hysterectomy postoperative epidural analgesia,it is worth of widely use in clinical.
