硬膜外腔注射吗啡联合静脉芬太尼患者自控镇痛临床效果观察  

Clinical observation of analgesia effects of single epidural morphine combined with patient-controlled intravenous fentanyl

作　　者：陈绍洋[1] 朱萧玲[1] 魏晓玲[1] 贺大银[1] 可焱[1] 胡胜[1] 熊利泽[1] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710033

出　　处：《第四军医大学学报》2004年第21期1969-1972,共4页Journal of the Fourth Military Medical University

基　　金：第四军医大学金桥工程资助项目 (0 1 0 1 5)

摘　　要：目的 :比较观察三种不同术后镇痛方法 ,旨在筛选更佳镇痛方案 .方法 :选择硬膜外麻醉下行胆囊或胆道手术患者 6 8例 ,按术后不同镇痛方法 ,随机分为三组 ,EM组 :硬膜外腔单次注射吗啡 2mg ;PCIFA组 :静脉芬太尼患者自控镇痛 ;MF组 :硬膜外腔单次注射吗啡 1mg联合静脉芬太尼患者自控镇痛 .采用视觉模拟评分法 (VAS)评估镇痛效果 ,观察术后 4 8h镇痛总体满意度、恶心、呕吐、皮肤瘙痒、尿潴留等并发症发生率以及胃肠功能恢复时间 .结果 :MF组术后 2 4h ,4 8h的VAS评分明显低于PCIFA组 (P <0 .0 5 ) ,尽管其 6h ,2 4h的VAS评分与EM组无明显差异 ,但 4 8h的VAS评分明显低于EM组 .术后 4 8h镇痛总体满意度 ,MF与EM相似 ,都明显好于PCIFA组 (P <0 .0 5 ) .恶心的发生率三组无明显差异 ,但呕吐的发生率MF组与PCIFA组明显高于EM组 (P <0 .0 1) ;皮肤瘙痒和尿潴留的发生率EM组都明显高于PCIFA组 (P <0 .0 5 ) ;三组对胃肠蠕动功能的影响都无明显差异 .结论 :硬膜外腔单次应用吗啡联合静脉芬太尼患者自控镇痛不但能提供更好的镇痛效果 ,而且并不增加术后恶心、呕吐等并发症的发生率 ,是一种较好的术后镇痛方案 .AIM: To explore the analgesia effects of single epidural morphine combined with patient-controlled intravenous fentanyl. METHODS: In a prospective study, 68 patients after operations on gall bladder or bile duct were randomly divided into 3 groups: single epidural morphine group (EM), patient-controlled intravenous fentanyl group (PCIFA), and single epidural morphine combined with patient-controlled intravenous fentanyl (MF). 2 mg morphine via the epidural route was given in EM group, fentanyl was given via the vein in PCIFA group, and 1 mg morphine via the epidural and fentanyl via the vein were given in MF group. The effects of analgesia were evaluated by visual analogue scale (VAS), and the incidence of complications including nausea, vomiting, itch of skin and retention of urine and the recovery of the digestive tract’s function were observed for 48 h post-operation. RESULTS: The VAS of 24 h and 48 h after operation in MF group was significantly lower than that of the PCIFA group (P<0.05), but no significant differences were found between those of MF and EM groups 6 h and 24 h after operation. The analgesic satisfaction rate of MF group was similar to that of EM group but higher than that of PCIFA group (P<0.05). No significant differences were found in the incidence of nausea and the recovery of digestive tract’s function among the three groups. The incidence of vomiting of MF and PCIFA groups was higher than that of EM group, and the incidences of the itch of skin and the retention of urine of EM group were higher than those of PCIFA group (P<0.05). CONCLUSION: Single epidural morphine combined with patient-controlled intravenous fentanyl, can provide more effective analgesia effects while not increase the incidences of complications.

关 键 词：术后镇痛效果 患者自控镇痛 硬膜外注射 吗啡 芬太尼 

分 类 号：R614.2[医药卫生—麻醉学]