【摘要】 目的　研究腰 -硬联合麻醉后罗哌卡因硬膜外持续输注加吗啡PCA方法的安全性。方法　选择阴式全宫切除术的患者 75例 (ASAⅠ～Ⅱ级 ) ,随机分为 3组。A ,B组 (n各为 2 5 ) ,选择腰 -硬联合麻醉 (CSEA) ;C组 (n =2 5 ) ,选择连续硬膜外麻醉 (CEA)。 3组术毕均保留硬膜外导管 ,回病房开启PCA泵 ,行PCEA ,双盲对照观察。其中A ,C组采用单泵 ,镇痛液为 0 .2 %罗哌卡因 (Rop) +0 .0 1%吗啡 (Mor) ,以LCP模式给药 ,负荷剂量 ( 5ml) +持续剂量 ( 1ml /h) +PCA剂量 ( 1ml/次 ) ,锁定时间 10min ,4h限量为 12ml。B组采用双泵给药 ,一泵镇痛液为 0 .2 %Rop ,用持续输注模式给药 ( 4ml/h) ,另一泵镇痛液同A ,B组 ,仅用PCA模式给药 ,Bolus剂量为 1ml/次 ,锁定时间 10min。结果　各组各时点VAS评分基本相似 ,B组患者舒适评分有所改善。另外 ,3组患者术后 4h均无运动阻滞。B组罗哌卡因的用量显著大于A ,C组 (P <0 .0 1) ;B组吗啡的用量显著小于A ,C组 (P <0 .0 1)。副作用 :恶心呕吐、瘙痒、嗜睡等B组明显减少 ;术后各组无呼吸抑制和术后头痛现象。结论　腰 -硬联合麻醉后罗哌卡因硬膜外持续输注加PCA用于阴式全宫切除术后镇痛是安全、有效的更多还原

【Abstract】 Objective To evaluate the safety of combined continuous infusion of ropivacaine with morphine PCEA in epidural space after combined subarachnoid epidural anesthesia (CSEA). Methods 75 patients (ASA Ⅰ～Ⅱ)undergoing vaginal total hysterectomy were randomly alloted into 3 groups: Group A and B(each 25 cases), received CSEA; Group C( n =25), received CEA. In Group A and C, PCEA with 0.01% morphine and 0.2% ropivacaine, loading dose was 5 ml, followed by continuous infusion 1 ml/h , PCA 1 ml bolus and lock out time was 10 min.Group B treated double pump, one with 0.2% ropivacaine continuous infusion 4 ml/h . Another was the same as group A and B’s only with PCA, and dosage was 1 ml each time, lock out time was 10 min. Results Visual analogy score (VAS) in each group was similar. Bruggrmann comfort score was improved in group B. There was movemant retardation in three groups 4 h ours later. Group B used more ropivacaine and less morphine than Group A and C( P <0.01). Side effect:nausea and vomiting, pruritus, drowsy etc were less in group B, there was no respiratory suppression and postoperative headache in three groups. Conclusion Combined continuous infusion of ropivacaine with morphine PCA in epidural space after CSEA are safe and effective .更多还原