盐酸羟考酮复合罗哌卡因用于剖宫产患者术后硬膜外镇痛的临床观察

摘要

Objective To observe the clinical effects of oxycodone hydrochloride combined with ropivacaine for pa -tient-controlled epidural analgesia in patients after undergoing cesarean section .Methods Ninety patients undergoing elec-tive cesarean section ranged from 20 to 34 years old were randomly divided into three groups:oxycodone group (Group O), fentanyl group (Group F) and control group (Group C).Three groups were treated with 0.75%ropivacaine 1.5 ml for sub-arachnoid block anesthesia .The patients in group O were treated with oxycodone hydrochloride 50 mg and ropivacaine 200 mg.The patients in group F were treated with fentanyl 0.5 mg and ropivacaine 200 mg, while the control group was treated with ropivacaine 200 mg, which were diluted to 100 ml for PECA.The baseline dose of PECA was 2 ml/h, and the patient-controlled dose was 0.5 ml.The lock time was 15 minutes and the duration was 48 h.The scores of VAS and Ramsay of three groups at 4 h, 8 h, 12 h, 24 h, 48 h after surgery.The pressing times of PECA, the frequency and dose of analgesia within 48 h were recorded .The comfortable satisfaction of PECA in three groups was followed -up.Results Compared with group C, the VAS score was significantly decreased at 4 h, 8 h, 12 h, 24 h, 48 h after surgery and the pressing times of PECA . The frequency and dose of dezocine within 48 h were lower in group O and group F , while the Ramsay score were significantly increased at 4 h, 8 h, 12 h, 24 h after surgery in group O and group F (P<0.05).Compared with group F, the incidence of nausea, vomiting, lethargy and pruritus within 48 h were significantly decreased in group O and group C (P<0.05).The comfortable satisfaction of PECA in group O and group F were significantly higher than that in group C , and the comfortable satisfaction in group O was higher than group F (P<0.05).Conclusion Oxycodone hydrochloride combined with ropiva-caine can be effectively used for patient -controlled epidural analgesia in patients after undergoing cesarean section , while less adverse drug reactions .%目的：观察盐酸羟考酮复合罗哌卡因用于剖宫产患者术后硬膜外镇痛（ PCEA）的临床效果。方法选取择期行剖宫产术的患者90例，年龄20～34岁，ASAⅠ～Ⅱ级。将患者随机分为三组，羟考酮组（ O组）、芬太尼组（ F组）和对照组（ C组），每组30例。三组患者均采用0.75％罗哌卡因1.5 ml行蛛网膜下腔阻滞麻醉，O组术后PCEA采用盐酸羟考酮50 mg＋罗哌卡因200 mg，F组采用芬太尼0.5 mg＋罗哌卡因200 mg，C组单用罗哌卡因200 mg，三组均稀释至100 ml，PCEA持续给药量2 ml／h，自控给药量0.5 ml／次，锁定时间15 min，镇痛持续48 h。分别于术后第4、8、12、24、48 h对三组患者进行VAS评分和Ramsay评分；记录三组患者术后48 h内PECA按压次数、补充镇痛次数及剂量；记录三组患者术后48 h不良反应的发生率；随访三组患者对PCEA的满意度。结果与C组比较， O组和F组患者在术后第4、8、12、24、48 h VAS评分明显降低，术后第4、8、12、24 h Ramsay评分明显升高，且术后48 h内PCEA按压次数、地佐辛补充镇痛次数及剂量明显降低（ P＜0.05）；与F组比较，O组和C组患者术后48 h内恶心呕吐、嗜睡和皮肤瘙痒的发生率明显降低（ P＜0.05）；O组和F组患者对PCEA的满意度明显高于C组，且O组满意度较F组升高（P＜0.05）。结论盐酸羟考酮复合罗哌卡因用于剖宫产患者术后PCEA镇痛效果明显，且药物不良反应少。