高浓度／低容量与低浓度／高容量左旋布比卡因在胸科术后硬膜外镇痛的效果比较

摘要

Objective To compare the efficacy and safety of large concentration/small volume versus small concentration/large volume of levobupivacaine for patients undergoing epidural analgesia after thoracic operation.Methods Fifty-eight lung cancer patients undergoing common thoracic operation were randomly divided into large concentration/small volume levobupivacaine group( Group A) and small concentration/large volume levobupivacaine group( Group B) ,with 29 cases in each group.The same preoperative and intraoperative therapies,anesthetic methods and surgical procedures were performed in the two groups.Group A had been given epidural analgesia with 0.25%of levobupivacaine(100 ml) 15 minutes before the operation was finished,while Group B had been given epidural analgesia with 0.125%of levobupivacaine(200 ml) 15 minutes before the operation was finished.The duration of analgesia was 48 hours in the two groups.The visual analogue scale(VAS) score,Ramsay sedation scale score,Bromage score,heart rate(HR),mean arterial pressure (MAP),oxygen saturation(SpO2) and adverse reactions were observed 4,8,12,24 and 48 hours after operation in the two groups.Results Group B gained lower VAS scores,Bromage scores and MAP at each time point compared with Group A(all P<0.05),but Ramsay sedation scale scores at each time point in Group B were higher than those in Group A(all P<0.05).There was no significant difference in the HR or SpO2 between two groups(P>0.05).Conclusion Small concentration/large volume of levobupivacaine applied to epidural analgesia after thoracic surgery owns the characteristics of better analgesic and sedative effects,less motor nerve block and greater MAP fluctuation compared with large concentration/small volume of levobupivacaine.%目的：比较高浓度／低容量与低浓度／高容量左旋布比卡因镇痛液在胸科术后硬膜外镇痛中的效果及安全性。方法将开胸手术肺癌患者58例，采用随机数字表法分为高浓度／低容量组（A组）与低浓度／高容量组（B 组），每组29例，两组术前、术中措施、麻醉及术式均相同，于手术结束前15 min，A组用0．25％左旋布比卡因100 ml，B组用0．125％左旋布比卡因200 ml硬膜外镇痛，两组镇痛时间均为48 h。观察两组术后4 h、8 h、12 h、24 h及48 h视觉模拟镇痛评分（ VAS）、Ramsay镇静评分、Bromage运动神经阻滞评分、心率、平均动脉压、血氧饱和度和不良反应。结果 B组各时点VAS、Bromage运动神经阻滞评分，平均动脉压均低于A组（P均＜0．05），但B组各时点的Ramsay镇静评分高于A组（P均＜0．05），两组心率、血氧饱和度比较，差异无统计学意义（P＞0．05）。结论与高浓度／低容量相比，低浓度／高容量左旋布比卡因镇痛液用于胸科术后硬膜外镇痛，具有镇痛、镇静效果好、运动神经阻滞效应轻、平均动脉压波动大等特点。