舒芬太尼复合吗啡硬膜外术后镇痛的观察.docVIP

舒芬太尼复合吗啡硬膜外术后镇痛的观察 中文摘要 目的观察舒芬太尼复合吗啡破膜外术后镇痛的效果及不良反应。 方法选择60例ASA 1 - II、年龄20-60岁，腰破联合阻滞下行腹式子宫切 除术的病人，术后破膜外镇痛随机分为三组(n=20)： 1组(吗啡组)吗啡3吨配伍 氟哌利多2. 5mg及1%罗哌卡因20mg； 1M1 (舒芬太尼组)舒芬太尼20眩配伍氟哌 利多2. 5mg及1%罗哌卡因20mg； III^L (舒芬太尼复合吗啡组)舒芬太尼10Ag,吗 啡1. 5mg配伍氟哌利多2. 5mg及1%罗哌卡因20mg?术中监测生命体征,记录术 后24小吋内的镇痛效果、不良反应及辅助纱物的使用情况。镇痛效果评价采用 视觉模拟评分(Visual Analogue Scale; VAS)标准。VAS03分认为镇痛有效。 结果II组、III组2h,4h,6h的VAS评分与I组比较明显较低(p 0. 05) ； 1 组和III组的有效镇痛时间均长于11组且有显著性(p 0. 05) ； II组，III组术后24h 恶心呕吐发生率与1组比较差界无显著性(p 0. 05): 1组瘙痒发生率与II组、 山组比较明显较高(P 0. 05):其他副反应如呼吸抑制、嗜睡、心动过缓等三组 间比较无明显差异(PO. 05) o 结论 舒芬太尼复合吗啡具有明显早期镇痛作用，舒芬太尼镇痛吋间较短， 破膜外吗啡镇痛时间长但早期镇痛不完善，硬膜外注射舒芬太尼复合小剂量吗啡 不但镇痛作用时间长并且早期镇痛完善，副作用少，是一种较好的镇痛方法。 关键词舒芬太尼；术后镇痛；吗啡；破膜外注射；罗哌卡因 Clinical study of epidural postoperative analgesia with sufentanil -morphine combination Abstract Objective To investigate the postoperative analgesic effect and adverse effects with epidural combination of sufentanil and morphine . Methods Sixty ASA 1 -11 patients aged 20-60 years , weighting 45-75kg undergoing abdominal hysterectomy surgery were randomly allocated into three groups. In group 1 patients received morphine 3mg plus 1% ropivacaine 20mg and droperidol 2.5mg through epidural catheter; In group II patients received sufentanil 20pg plus 1% ropivacainc 20mg and droperidol 2.5mg and in groupIII patients were given sufentanil lO^g and morphine 1.5mg plus 1% ropivacaine and droperidol 2.5mg. Postoperative pain was recorded at postoperative times 2h, 4h, 6h, 8h, 12h, 18h and 24h. Postoperative pain was rated on a visual analogue scale (VAS) and absolute VAS3 was considered an analgesic success. Additional analgesics and adverse effects such as respiratory depression, urinary retention, pruritus, sedation, nausea and vomiting were recorded in the first postoperative 24h. Results VAS scores were significantly decreased at postoperative time 2, 4 and 6h in groups II , ITI(p0.05),and patients in groups I and III obtained Ion ger duration of effective analgesia(p 0.05). There were no