右旋美托咪啶对罗哌卡因配伍喷他佐辛硬膜外镇痛效应的影响

摘要

Objective To investigate the effect of dexmedetomidine on the analgesic effect of postoperative patient-controlled epidural analgegia (PCEA) using 0.1% pentazocine and 0.2% ropivacaine after transabdominal hysterectomy. Methods One hundred and twenty patients undergoing transabdominal hysterectomy were divided randomly into three groups: group P1, P2, P3 (n=40). Patients in the three groups all received postoperative patient-controlled epidural analgegia (PCEA) using 0.1% pentazocine added to 0.2% ropivacaine. The model of PCA was LCP with loading dose (LD, dexmedetomidine 0.5 μg/kg or Physiological saline) 5 ml+ continue infusion dose (CI) 1 ml+ bolus dose 3 ml in group P1 or P3, and that with LD (Physiological saline) 5 ml+CI 2 ml+bolus dose 2 ml in group P2. The total dosage of ropivacaine and pentazocine, the duration of motor block, VAS score of wound pain 1 h, 2 h, 4 h, 8 h, 16 h, 24 h after PCA pump and adverse effects were recorded. Results The total dosage of ropivacaine and pentazocine in group P3 was significantly lesser than group P1 (P<0.05). Duration time of motor block with Group P3 was significantly shorter and incidence of shiver was significantly lower than those in Group P1 (P<0.05). VAS of wound pain in group P2, P3 was lower than that in group P1 (P<0.05), while that in group P2, P3 showed no statistically significant difference (P>0.05). Conclusion Dexmedetomidine 0.5 μg/kg given by epidural injection improves the quality and the duration of postoperative analgesia, and also provides an analgesic sparing effect in patients undergoing transabdominal hysterectomy.%目的 观察右旋美托咪啶对0.2%罗哌卡因配伍0.1%喷他佐辛硬膜外患者自控镇痛(PCA)用于经腹子宫全切术后患者的镇痛效应的影响.方法 120 例择期经腹子宫全切术患者随机分成P1、P2、P3 组(n=40),均采用0.2%罗哌卡因配伍0.1%喷他佐辛的配药方式,镇痛泵模式为负荷剂量(LD)+持续输注剂量(CI)+PCA追加剂量(Bolus)模式(LCP 模式)行硬膜外患者自控镇痛(PCEA);P1、P2 组负荷剂量为生理盐水5 ml,P3 组为静脉注射右旋美托咪啶0.5 μg/kg 共5 ml,P1 组及P3 组采用持续剂量(1 ml)+PCA追加剂量(3 ml),P2 组采用持续剂量(2 ml)+ PCA追加剂量(2 ml),分别记录患者运动阻滞功能恢复至0级时间及各组患者硬膜外用药量,以及开启PCA泵后1 h、2 h、4 h、8 h、16 h、24 h各时点的VAS评分,记录患者对PCA的综合满意度及不良反应.结果 与P1组比较,P3组患者运动阻滞时间延长、硬膜外药物用量减少、寒颤的发生率降低(P<0.05);各时段VAS评分P2、P3组低于P1组(P<0.05),P2、P3组比较差异无统计学意义(P﹥0.05).结论 硬膜外单次注射右旋美托咪啶0.5 ug/kg能增强罗哌卡因配伍喷他佐辛的硬膜外镇痛效应,降低硬膜外用药量及降低寒颤等不良反应的发生率.