目的：比较观察不同浓度罗哌卡因椎旁阻滞应用于单侧开放性输尿管切开取石术后镇痛的效果。方法60例ASAⅠ或Ⅱ级择期行单侧开放性输尿管上段切开取石术患者，随机分为低浓度罗哌卡因组（0．15％）和高浓度罗哌卡因组（0．25％），两组术后采用连续椎旁神经阻滞镇痛。观察两组患者术后1、6、12、24、48 h的动静态VAS，血流动力学变化，血清皮质醇、β内啡肽水平和术后镇痛并发症。并在镇痛结束后统计患者对镇痛治疗的总体满意度。结果高浓度组患者在术后1、6、12、24、48 h的VAS、血清皮质醇及β内啡肽水平均显著低于低浓度组（均P＜0．05），两组患者术后MAP和SpO2、术后并发症发生率及术后对镇痛满意度均无显著性差异（均P＞0．05）。结论应用罗哌卡因行术后椎旁神经阻滞镇痛，应适当提高药物浓度，才能达到更好的镇痛效果。%Objective To obtain the optimal effective concentration of Ropivacaine as paravertebral block for easing postoperative rehabilitation pain resulting from unilateral ureterolithotomy.Method Sixty ASA Ⅰor Ⅱpatients were randomly divided into 2 groups ( n =30 each ) , the high concentration group ( 0.25% ropivacaine ) and the low concentration group (0.15% ropivacaine).After operation, all patients were treated with paravertebral block for easing postoperative rehabilitation pain.Visul analog scores (VAS) during rest and exercise, MAP,SpO2,Serum corticosteroid ( Cor) ,β-endorphin and postoperative complications were recorded.Findings The VAS during rest and exercise at all time points in the high concentration group were significantly lower than in the low concentration group.The concentrations of Serum corticosteroid( Cor) ,β-endorphin in the high concentration group were lower than in the low concentration group. There was no significant difference in hemodynamics and postoperative complications.Conclusion Ropivacaine 0.25%concentration can serve as a desirable medicine for easing postoperative rehabilitation pain.
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