盐酸氯普鲁卡因用于经尿道前列腺电切术后硬膜外镇痛的临床研究

Clinical Research about Chloroprocaine Used for Epidural Analgesia after Transurethral Resection of the Prostate

关键词:  硬膜外镇痛  氯普鲁卡因  经尿道前列腺电切  膀胱痉挛

Key words:  epidural analgesia  chloroprocaine  transurethral resection of the prostate  bladder spasm

摘要:

目的 观察国产盐酸氯普鲁卡因用于老年人经尿道前列腺电切术后硬膜外镇痛的临床效果。方法 选择60~75岁行经尿道前列腺电切术患者80例，随机双盲分为A、B、C、D 4组(n=20)。术中均行L_3-4 3%盐酸氯普鲁卡因硬膜外麻醉，术后予硬膜外持续镇痛，剂量分别为A组生理盐水100 mL，B、C、D 3组分别予1%，1.2%和1.5%盐酸氯普鲁卡因各100 mL，持续镇痛3 d，连续监测患者视觉模糊评分(VAS评分)、改良Bromage评分、膀胱痉挛次数、患者镇痛满意程度、呼吸循环变化和中枢神经系统反应等。结果 A组VAS评分及膀胱痉挛次数于安返病房6 h后均较B、C、D 3组明显为高，具有统计学差异(P<0.01)；B组VAS评分及膀胱痉挛次数均较C、D 2组为高，但无统计学差异；C、D 2组VAS评分无差异，但D组膀胱痉挛次数略低于C组。4组术后6 h Bromage评分均为0级。A组有11位患者对镇痛满意度低，表示不能耐受；B组除有3位患者满意度稍低外，其余表示满意；C、D 2组患者均对镇痛效果满意，除D组有2例患者诉恶心、腹胀外，其余均无呼吸循环变化、中枢神经系统反应和其他不良反应。结论 盐酸氯普鲁卡因用于老年人经尿道前列腺电切术后硬膜外镇痛，1.2%即可满足患者镇痛需要，降低膀胱痉挛次数，又无不良反应的发生，其术后镇痛效果令人满意。

Abstract:

OBJECTIVE To observe the effects of chloroprocaine used in clinical epidural analgesia for the elder who had accepted transurethral resection of the prostate (TURP). METHODS Eighty patients of 60-75-year-old were enrolled in the randomized and double-blind study. They were divided into A, B, C and D four groups (n=20). All patients accepted L_3-4 3% chloroprocaine epidural anesthesia. After they were undergo TURP, the patients remained the epidural catheter for continuous epidural chloroprocaine hydrochloride analgesia for 3 days according to different doses: A group: 0.9% NS; B group: 1% chloroprocaine; C group: 1.2% chloroprocaine and D group: 1.5% chloroprocaine. We monitored the blurred vision score (VAS score), modified Bromage score, the number of bladder spasms, respiratory and circulatory changes, central nervous system reactions, and degree of satisfaction for all the patients. RESULTS For the VAS score and frequency of bladder spasm, the means of A group were less than those in B, C, and D group with significant statistics difference (P<0.01), the means of B group was less than those in C and D groups, but no statistical difference. Though C and D groups had no difference in VAS score, but the number of bladder spasm of D group was less than C group. The Bromage score of four groups were 0 in postoperation-6h. Nearly 11 patients in A group had low satisfaction and could not tolerate, most patients with continuous epidural chloroprocaine hydrochloride analgesia had satisfied with the analgesic effect. All patients had no respiratory and circulatory changes and the adverse reaction in the central nervous system. CONCLUSION The chloroprocaine used in epidural analgesia after TURP for the elder had good analgesia effect and safty.