硬膜外T12-L1或L1-L2置管PCEA在妇科腹腔镜手术后镇痛的比较

Comparison of the Effects of T12-L1 and L1-L2 Epidural Analgesia for Postoperative Analgesia after Gynecological Laparoscopy

摘要: 目的：比较行硬膜外T12-L1置管和硬膜外L1-L2置管用于妇科腹腔镜手术患者术后镇痛的效果。方法：选取于2016年6月-2017年4月在宜宾市第二人民医院麻醉科接受妇科腹腔镜手术的患者164例，ASAI或Ⅱ级，随机分为T组(n = 82)和L组(n = 82)，术前分别在T12-L1 (T组)和L1-L2 (L组)行硬膜外穿刺置管，镇痛泵的配置均为100 ml内50 ug舒芬太尼与0.894%的甲磺酸罗哌卡因22 ml，两组均行PCEA。观察并记录两组患者首次按压镇痛泵的时间，术后首次下床活动时间，术后4、8、12、24和48 h患者的疼痛VAS评分，BCS舒适度评分，术后48 h内舒芬太尼及罗哌卡因的使用情况；记录术后恶心呕吐、尿潴留、双下肢麻木、眩晕、皮肤瘙痒等不良反应的发生情况。结果：两组患者均未观察到硬膜外穿刺相关并发症。T组患者术后首次按压镇痛泵的时间明显长于L组(P < 0.05)，首次下床活动时间明显早于L组(P < 0.05)；与L组比较，T组术后8 h、12 h、24 h的VAS评分降低，BCS评分升高(P < 0.05)；术后0~12 h、12~24 h、24~36 h T组使用舒芬太尼和罗哌卡因剂量明显小于L组(P < 0.05)。T组术后恶心呕吐、眩晕，皮肤瘙痒等不良反应的发生情况的发生率与L组无明显差异，尿潴留、双下肢麻木发生率明显低于L组。结论行硬膜外T12-L1置管较L1-L2置管PCEA能够更加有效地为妇科腔镜手术患者提供理想的术后镇痛效果，并且可以减少术后阿片类及局部麻醉药物用量及不良反应的发生，有利于促进患者康复。

Abstract: Objective: To compare the effects of T12-L1 and L1-L2 epidural analgesia for postoperative analge-sia after gynecological laparoscopy. Methods: One hundred and sixty four female patients undergo-ing gynecological laparoscopy, all falling into ASA I or II were randomly divided into group T (n = 82) and group L (n = 82). Epidural intubation was completed for group T or group L. Patient-controlled epidural analgesic (PCIA) pumps were started at the end of surgery. The first additional analgesia request, the first time getting out of bed, and VAS and BCS score, consumption of sufentanil at 0 - 12 h, 12 - 24 h, 24 - 36 h after operation were recorded. Postoperative nausea and vomiting, dizziness, skin itching were recorded. Results: Patients in both groups have no T or L-related complication. The first additional analgesia request was significantly delayed in group T than in group L (P < 0.05). The time getting out of bed in group T was significantly earlier than that in group L. Compared with L group, VAS scores were significantly lower and BCS score were significantly higher at postoperative 8, 12, 24 h (P < 0.05) in T group. Patients in T group used significantly less sufentanil than that of L group (P < 0.05) at 0 - 12 h, 12 - 24 h, 24 - 36 h after surgery. Side effects like postoperative nausea and vomiting, dizziness and skin itching were significantly less in T group (P > 0.05). Conclusion: T12-L1 epidural intubation can more effectively supply postoperative analgesia than L1-L2 intubation; it also reduces postoperative sufentanil consumption and side effect.