左旋布比卡因用于良性前列腺增生摘除術(shù)后患者自控硬膜外鎮(zhèn)痛效果

1、左旋布比卡因用于良性前列腺增生摘除術(shù)后患者自控硬膜外鎮(zhèn)痛效果及循環(huán)應(yīng)激反應(yīng)的影響 07-11-13 11:26:00 作者：孫福龍編輯：studa20【關(guān)鍵詞】 良性前列腺增生 摘要：目的：研究左旋布比卡因伍用芬太尼在良性前列腺增生摘除術(shù)后患者自控硬膜外鎮(zhèn)痛效果及循環(huán)應(yīng)激反應(yīng)的影響。方法：隨機(jī)選擇ASAI級(jí)，年齡5575歲、擇期作良性前列腺增生恥骨上經(jīng)膀胱前列腺摘除術(shù)40例為患者自控硬膜外鎮(zhèn)痛組（PCEA組），另隨機(jī)選擇同類手術(shù)患者40例為哌替啶肌注鎮(zhèn)痛組（PMA組）。在PCEA組鎮(zhèn)痛藥液為芬太尼0.5mg、氟哌利多5mg和左旋布比卡因187.5mg用生理鹽水配至100ml。PMA組當(dāng)患者疼痛

2、難忍時(shí)，每次肌注哌替啶0.8mg/kg。分別采用視覺(jué)模擬評(píng)分（VAS）評(píng)定鎮(zhèn)痛效果，監(jiān)測(cè)并記錄麻醉前、術(shù)畢、術(shù)后6、12、24h的BP、HR值，并計(jì)算心率收縮壓之積（RPP），同時(shí)采肘靜脈血，用高效相色譜法測(cè)定血漿去甲腎上腺素（NE）和腎上腺素（E）的濃度，術(shù)后膀胱沖洗量、出血量膀胱痙攣兩組患者例數(shù)，鎮(zhèn)痛期間的不良反應(yīng)。結(jié)果：術(shù)后各時(shí)點(diǎn)的VAS評(píng)分PCEA組較PMA組顯著低（p0.05或p0.01）PMA組術(shù)后各時(shí)點(diǎn)的HR、SBP、RPP、CA及術(shù)后6、12h的DBP均較麻醉前明顯增高（P0.05P或0.01），PCEA組除NE于術(shù)后6h較麻醉前高外（P0.01）,其余指標(biāo)與其麻醉前相比無(wú)顯著

3、差異（P0.05），術(shù)后各時(shí)點(diǎn)的RPP、血漿CA及術(shù)后6、12h的SBP、DBP、HR值均明顯低于PMA組（P0.05或P0.01）。術(shù)后膀胱沖洗量、出血量、膀胱痙攣例數(shù)PMA組均高于PCEA組（P0.05）。結(jié)論：左旋布比卡因伍用芬太尼在良性前列腺增生摘除術(shù)后患者自控硬膜外鎮(zhèn)痛效果理想對(duì)循環(huán)應(yīng)激反應(yīng)的影響較小。關(guān)鍵詞： 左旋布比卡因； 硬膜外； 鎮(zhèn) 痛； 良性前列腺增生Effect of PCEA with L-bupivacaine after Benign Prostatectomy and its Influence on Stress Response of Circulation

4、Abstract: Objective:To study the effect of postoperative patient-controlled epidural analgesia with L- bupivacaine and fentanyl after benign prostatectomy and its influence on the stress response of circulation.Methods:Forty cases ASA undergone elective prostatectomy,aged from 55 to 75,were randomly

5、 enrolled into the patient-controlled epidural analgesia group(PCEA). Forty other cases suffered the similar symptoms were randomly enrolled into the pethidine intramuscular injection group (PMA).In the PCEA group, 100ml Sodium Chloride contains fentanyl 0.5mg, droperidol 5mg and L-bupivacaine187.5m

6、g. In the PMA group, pethidine 0.8mg/kg was injected each time when the patient cant bear.The effect was evaluated by visual analogue pain scales.Blood pressure(BP)and heart rate(HR) was monitored and recorded before aneshtesia,at completion of operation and 6 hours, 12 hours, 24 hours postoperative

7、ly.The result of HR multiplied by systolic BP was also recorded.At the same time blood sample was taken through ulnar vein.The concentration of plasma NE and E was detected by high performance liquid chromatography .Flushing dose of bladder,hemorrhage volume, the number of patients suffered bladder

8、spasm and adverse reaction postoperatively were recorded in detail.Results:VAS of the PCEA group was significantly lower than that of the PMA group (P0.05 or P0.01 ) at each period postoperatively.In the PMA group HR,SBP,RPP,CA at every period and DBP at 6 hours,12 hours postoperatively was signific

9、antly higher(P0.05 or P0.01) than that of before aneshtesia.Compared with the parameter before aneshtesia , there is no significant different in the PCEA group.Only the NE is significant higher than that of before aneshtesia in the PCEA group.In the PCEA group RPP, plasma CA at every period and SBP,

10、DBP , HR at 6 hours,12 hours postoperatively was significantly lowerer than that of the PMA group (P0.05 or p0.01 ). Flushing dose of bladder,hemorrhage volume, the number of patients suffered bladder spasm in the PMA group was significant higher than that of the PCEA group(p0.05 ).Conclusion: Patie

11、nt-controlled epidural analgesia with L-bupivacaine and fentanyl postoperatively after benign prostatectomy is highly effective and has little influence on stress response of circulation.Key words: L-bupivacaine; Epidural; Analgesia; Begin prostate硬膜外腔持續(xù)泵入芬太尼和布比卡因混合液，產(chǎn)生節(jié)段性鎮(zhèn)痛，效果確切，現(xiàn)已廣泛用于術(shù)后鎮(zhèn)痛1。本研究旨在探討

12、左旋布比卡因伍用芬太尼在良性前列腺增生摘除術(shù)后患者自控硬膜外鎮(zhèn)痛效果及循環(huán)應(yīng)激反應(yīng)的影響。1 資料與方法1.1 一般資料：選擇ASAI級(jí)，年齡5575歲、擇期作良性前列腺增生恥骨上經(jīng)膀胱前列腺摘除術(shù)80例，隨機(jī)分為患者自控硬膜外鎮(zhèn)痛組（PCEA組）和哌替啶肌注鎮(zhèn)痛組（PMA組）各40例。所有患者術(shù)前心肺功能正常，無(wú)內(nèi)分泌及嚴(yán)重肝、腎疾患，無(wú)硬膜外穿刺禁忌癥。1.2 麻醉方法：術(shù)前30min肌注苯巴比妥鈉0.1g、阿托品0.5mg。全部病人術(shù)中均用連續(xù)硬膜外麻醉。選擇23行硬膜外穿刺置管。0.33的卡因維持術(shù)中麻醉，酌情靜注杜非合劑1.52ml，術(shù)中維持生命體征平穩(wěn)。手術(shù)結(jié)束后將患者送回病房，接監(jiān)護(hù)儀監(jiān)測(cè)生命體征。1.3 術(shù)后鎮(zhèn)痛：PCEA組于術(shù)畢給予0.25左旋布比卡因4ml，接PCAD泵作PCEA。鎮(zhèn)痛藥液為芬太尼0.5mg、氟哌利多5mg和左旋布比卡因187.5mg用生理鹽水配至100ml。常規(guī)液速2ml/h，追加量為0.5ml/次，鎖定時(shí)間15min，鎮(zhèn)痛時(shí)間為2448h。PMA組：當(dāng)患者疼痛難忍時(shí)，每次肌注哌替啶0.8mg/kg。1.4 觀察指標(biāo)：鎮(zhèn)痛效果：采用視覺(jué)模擬評(píng)分（