不同浓度罗哌卡因切口持续浸润用于乳腺癌患者术后镇痛的效果

摘要

Objective To observe the effect of continuous incision infusion different concentra-tion of ropivacaine for postoperative analgesia after radical mastectomy.Methods One hundred pa-tients under radical mastectomy,aged 40-70 years,ASA Ⅰ or Ⅱ,were randomly divided into four groups (n =25 each):0.2% (group R1),0.3% (group R2),0.4% (group R3)ropivacaine incision continued infiltration group and patient-controlled intravenous analgesia (group PCIA)as control group.VAS pain scores,sedation Ramsay score and side effects were recorded at each time point in rest and turning over 90°,2 h (T1 ),4 h (T2 ),8 h (T3 ),12 h (T4 ),24 h (T5 ),48 h (T6 )after the operation.Results VAS scores in group R1 at T1-T6 in rest and turn over 90°were significantly high-er than that of group PCIA (P <0.05).There were no significant differences among the group PCIA, group R2 and group R3.Sedation score in PCIA group was significantly higher than that in the other three groups (P <0.05),and the adverse reactions,such as nausea and vomiting,in group PCIA (2 cases)were more serious than that in the other groups (0 cases ).There were no significant differences among the other groups.Conclusion Ropivacaine plays an effective role in infiltration an-algesia when its concentration reaches 0.3% subcutaneous after radical mastectomy.%目的：观察罗哌卡因切口持续浸润用于乳腺癌患者术后镇痛的有效浓度。方法择期行乳腺癌根治术患者100例,年龄40~70岁,ASA Ⅰ或Ⅱ级,按照随机数字表法分为四组：0.2%(R1组)、0.3%(R2组)、0.4%(R3组)罗哌卡因切口持续浸润组和地佐辛复合曲马多患者静脉自控镇痛组(PCIA 组),每组25例。记录患者术后2 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、48 h (T6)时安静和90°翻身活动时的 VAS 疼痛评分、Ramsay 镇静评分及恶心、呕吐、头晕、呼吸抑制等不良反应发生情况。结果 T1~T6时 R1组安静和90°翻身活动时 VAS 评分明显高于 PCIA 组(P <0.05),R2和 R3组 VAS 评分与 PCIA 组差异无统计学意义。R1、R2和 R3组 Ramsay 镇静评分均明显低于 PCIA 组(P <0.05),三组间差异无统计学意义。PCIA 组出现2例恶心呕吐,其余各组均未发生恶心呕吐等不良反应。结论0.3%罗哌卡因切口持续浸润对乳腺癌根治术后镇痛安全有效。