氢吗啡酮复合罗哌卡因用于胸腹腔镜联合食道癌根治术后硬膜外自控镇痛的效果观察

Efficacy of Hydromorphone combined with Ropivacaine for patient controlled epidural analgesia after thoracoscopic-laparoscopic radical esophagectomy

摘要:

目的 观察氢吗啡酮复合罗哌卡因用于胸腹腔镜联合食道癌根治术后硬膜外自控镇痛（PCEA）的效果及安全性。方法 选择浙江省台州医院拟在全身麻醉复合硬膜外麻醉下行胸腹腔镜联合食道癌根治术的患者60例，随机分为氢吗啡酮复合罗哌卡因PCEA组（H组）和舒芬太尼复合罗哌卡因PCEA组（S组），每组各30例。H组：氢吗啡酮10 μg/mL+罗哌卡因1.25 mg/mL；S组：舒芬太尼0.3 μg/mL+罗哌卡因1.25 mg/mL。给药方案：负荷剂量为6 mL，维持剂量4 mL/h，自控剂量每次5 mL，锁时30 min。记录术后4、8、12、24和48 h静息和咳嗽时的视觉模拟评分（VAS）及下肢运动神经阻滞程度（改良Bromage分级）。记录术后48 h内PCEA的有效按压次数（D1）和实际按压次数（D2），并计算D1/D2，以评价镇痛满意度。记录术后48 h内不良反应发生情况和镇痛补救情况，并计算镇痛补救率。结果 H组术后4、8、12、24和48 h静息和咳嗽时VAS评分明显较S组低（P < 0.05）。H组术后48 h内PCEA的D1、D2和镇痛补救率明显低于S组（P < 0.05），D1/D2和镇痛满意度明显高于S组（P < 0.05）。两组患者术后4、8、12、24和48 h的改良Bromage分级和术后48 h内不良反应发生情况比较，差异均无统计学意义（P > 0.05）。结论 氢吗啡酮复合罗哌卡因用于胸腹腔镜联合食道癌根治术后，PCEA效果确切，不良反应少，且镇痛效果优于舒芬太尼复合罗哌卡因，患者满意度更高。

Abstract:

Objective To observe the efficacy and safety of Hydromorphone combined with Ropivacaine for patient controlled epidural analgesia (PCEA) after thoracoscopic-laparoscopic radical esophagectomy.Methods 60 patients scheduled for thoracoscopic-laparoscopic radical esophagectomy were randomly divided into two groups, Hydromorphone combined with Ropivacaine for PCEA group (group H, n = 30) and Sulfentanyl combined with Ropivacaine for PCEA group (group S, n = 30). Surgery was performed under combined general anesthesia and epidural anesthesia, and PCEA was given after surgery with different analgesia pump formula: Hydromorphone 10 μg/mL + Ropivacaine 1.25 mg/mL for group H and 0.3 μg/mL Sulfentanyl + 1.25 mg/mL Ropivacaine for group S. Dosage regimen: loading does was 6 mL, background infusion was 4 mL/h, bolus volume 5 mL, and lockout interval 30 minutes. The VAS scores at rest, on coughing and modified Bromage degrees were recorded at 4, 8, 12, 24 and 48 h after surgery. The effective pressing times (D1), the actual pressing times (D2), the effective/actual pressing times ratio (D1/D2) and patient satisfaction with analgesia were recorded within 48 h after surgery. The side effects and the remedial analgesia situation were documented and used to calculate the analgesic remedy frequency within 48 h after surgery.Results Compared with group S, the VAS scores at rest and on coughing at 4, 8, 12, 24 and 48 h after surgery in group H were significantly lower than those in group S (P < 0.05); D1, D2 and analgesic remedy frequency within 48 h after surgery in group H were significantly lower than those in group S (P < 0.05); D1/D2 and patient satisfaction with analgesia in group H were significantly higher than those in group S (P < 0.05). There was no significant difference between the two groups in the modified Bromage grade at 4, 8, 12, 24 and 48 h postoperatively and the incidence of adverse reactions within 48 h postoperatively (P > 0.05).Conclusion Administration of Hydromorphone combined with Ropivacaine for PCEA after thoracoscopic-laparoscopic radical esophagectomy provided definite analgesic efficacy and few side effects. Compared with Sulfentanyl combined with Ropivacaine for PCEA, Hydromorphone combined with Ropivacaine for PCEA had better analgesic effect and improved patient satisfaction.