CAJ | 학술논문

【目的】探讨硬膜外腔注入0．2％罗哌卡因对全麻下阑尾炎手术患者痛觉过敏的影响。【方法】选择2010年5月至2014年2月本院收治的100例全麻下行阑尾炎手术患者，美国麻醉师协会（A S A ）分级为Ⅰ～Ⅱ级，将患者随机分为罗哌卡因组和芬太尼组，每组各50例。罗哌卡因组：手术前先经硬膜外导管注射0．2％罗哌卡因10mL，术中每隔1h追加一次罗哌卡因5mL，于手术结束前再注射0．2％罗哌卡因10mL ；芬太尼组：手术前后分别经静脉注射芬太尼2μg／kg。观察两组患者入室时（T0）、诱导时（T1）、切皮时（T2）、术中探查时（T3）、关腹时（T4）及术毕时（T5）的SBP、DBP以及HR变化，记录拔管后1 h（T6）、4 h（T7）、12 h（T8）、24 h（T9）的视觉模拟评分法（V A S ）评分。记录比较患者术后12 h和24 h的触痛阈和机械痛觉过敏范围。【结果】罗哌卡因组患者的T2、T3时间点SBP、DBP低于芬太尼组患者，差异具有统计学意义（ P ＜0．05）；罗哌卡因组患者的T6、T7、T8、T9时点VAS评分均低于芬太尼组患者，差异具有统计学意义（ P ＜0．05）；罗哌卡因组患者三个测定点的触痛阈均高于芬太尼组患者，三条测定线上的机械痛觉过敏范围均较芬太尼组窄，差异具有统计学意义（ P ＜0．05）；术后12 h与24 h两组患者三个测定点的触痛阈均较术前低，差异有统计学意义（ P＜0．05）。【结论】经硬膜外腔注入低浓度0．2％罗哌卡因能够减少全麻下阑尾炎手术中的阿片类镇痛药物的用量，并且能够减轻患者术后痛觉过敏的范围和程度。
【목적】탐토경막외강주입0．2％라고잡인대전마하란미염수술환자통각과민적영향。【방법】선택2010년5월지2014년2월본원수치적100례전마하행란미염수술환자，미국마취사협회（A S A ）분급위Ⅰ～Ⅱ급，장환자수궤분위라고잡인조화분태니조，매조각50례。라고잡인조：수술전선경경막외도관주사0．2％라고잡인10mL，술중매격1h추가일차라고잡인5mL，우수술결속전재주사0．2％라고잡인10mL ；분태니조：수술전후분별경정맥주사분태니2μg／kg。관찰량조환자입실시（T0）、유도시（T1）、절피시（T2）、술중탐사시（T3）、관복시（T4）급술필시（T5）적SBP、DBP이급HR변화，기록발관후1 h（T6）、4 h（T7）、12 h（T8）、24 h（T9）적시각모의평분법（V A S ）평분。기록비교환자술후12 h화24 h적촉통역화궤계통각과민범위。【결과】라고잡인조환자적T2、T3시간점SBP、DBP저우분태니조환자，차이구유통계학의의（ P ＜0．05）；라고잡인조환자적T6、T7、T8、T9시점VAS평분균저우분태니조환자，차이구유통계학의의（ P ＜0．05）；라고잡인조환자삼개측정점적촉통역균고우분태니조환자，삼조측정선상적궤계통각과민범위균교분태니조착，차이구유통계학의의（ P ＜0．05）；술후12 h여24 h량조환자삼개측정점적촉통역균교술전저，차이유통계학의의（ P＜0．05）。【결론】경경막외강주입저농도0．2％라고잡인능구감소전마하란미염수술중적아편류진통약물적용량，병차능구감경환자술후통각과민적범위화정도。
[Objective] To explore the effects of epidural cavity injection of 0 .2% ropivacaine on hyperalgesia in patients undergoing appendicitis surgery under general anesthesia .[Methods]A total of 100 patients (American Society of Anesthesiologists classⅠ ~ Ⅱ) undergoing appendicitis surgery under general anesthesia from May 2010 to February 2014 were selected and randomly divided into two groups of ropivacaine (L) and fentanyl (F) .Group L :epidural catheter injection of 0 .2% ropivacaine 10 ml before surgery ,intraoperative 5 ml every 1 h to append ropivacaine inject and finally 10 mL before the end of surgery ;group F:intravenous fentanyl 2 μg/kg before and after operation .The timepoints were entry into operating room (T0 ) ,induction (T1 ) ,skin incision (T2 ) ,intraop‐erative exploration (T3 ) ,closure (T4 ) and completion (T5 ) .The values of systolic blood pressure (SBP) ,dias‐tolic blood pressure (DBP) and heart rate (HR) were recorded .And the visual analogue scale (VAS) scores were measured at 1 h post‐extubation (T6 ) ,4 h (T7 ) ,12 h(T8 ) and 24 h (T9 ) .At 12 h and 24 h postoperation ,ten‐derness threshold and mechanical hyperalgesia were evaluated .[Results] In group L at T6 ,T7 ,T8 and T9 ,VAS scores were lower than those of group F .And the differences were statistically significant ( P<0 .05);L group at T6 ,T7 ,T8 ,T9 ,VAS scores were lower than those of group F .And the differences were statistically significant ( P <0 .05);L group at 3 measuring points of bitterness threshold was higher than those of group F ,3 measure‐ment ranges of mechanical hyperalgesia were narrow in group F .And the differences were statistically significant ( P <0 .05);Compared with before operation ,two groups with 3 measuring points of tenderness threshold de‐creased after 12 h and 24 h .And the differences were statistically significant ( P<0 .05) .[Conclusion] An epi‐dural injection of 0 .2% ropivacaine may reduce opioid dosage during appendicitis surgery under general anesthesia . And it can reduce the scope and degree of postoperative hyperalgesia .