静脉预注可塞风对子宫全切病人硬膜外术后自控镇痛的影响  

Effects of preinjecting xafon on patient-controlled epidural analgesia for postoperative pain relief following hysterectomy

作　　者：旷昕[1] 郭曲练[1] 熊云川[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2006年第21期3271-3273,共3页China Journal of Modern Medicine

摘　　要：目的探讨静脉预注可塞风对子宫全切病人硬膜外术后自控镇痛的影响。方法对60例择期子宫全切手术患者,随机单盲分为3组,每组20例,Ⅰ组为空白对照组,切皮前静脉输注生理盐水10mL。Ⅱ组手术结束时静脉输注可塞风8mg。Ⅲ组切皮前10min静脉输注可塞风8mg。所有患者均于两点连硬外麻醉下手术。3组患者均于手术结束后硬膜外自控镇痛(PCEA)。自控镇痛液为布比卡因和芬太尼的混合液(布比卡因0.125%,芬太尼2μg/mL)负荷剂量5mL,背景剂量2mL/h,单注剂量2mL,锁定时间15min,限量10mL/h,术后镇痛维持48h。结果第1个24h自控镇痛的视觉模拟(VAS)评分静息时Ⅰ组与Ⅱ组比较P<0.05,Ⅰ组与Ⅲ组比较P<0.01;咳嗽时Ⅰ组与Ⅲ组比较P<0.01。第1个24h镇痛药用量Ⅰ组为(99±15),Ⅱ组为(83±8)mL,Ⅲ组为(78±9)mL;每2个24h镇痛药用量Ⅰ组为(81±10)mL,Ⅱ组为(80±5)mL,Ⅰ组与Ⅲ组比较P<0.01,Ⅰ组与Ⅱ组比较P<0.05。Ⅰ组呕吐率大于Ⅲ组。结论静脉预注可塞风加强了子宫全切病人硬膜外术后自控镇痛的效果,减少了术后呕吐发生率。[Objective] To compare the effect of preinjecting xafon on patient-controlled epidural analgesia for postoperative pain relief after hysterectomy. [Methods] 60 ASA Ⅰ-Ⅱ patients undergoing hysterectomy who were matched in age, weight, and duration of surgical procedure, were randomly allocated to one of the three treatment groups 20 in each： group Ⅰ injected saline 10 mL before skin incision, group Ⅱ injected xafon to the end surgery, and group Ⅲ injected xafon before skin incision. Patient-controlled epidural analgesia （0.125% Bupivocaine and 2 μg/mL fentanyl） was given for postoperative pain relief in all group （5 mL bolus followed by 2 mL/h infusion, PCA dose： 2 mL, lock out time： 15 min） Postoperative pain intensity at rest and during movement was assessed on a Visual analogue scale （VAS） by a blinded observer for 48 h after surgery. Analgesic requirements and side effects were compared among the three groups. [Results] In the first 24 h after surgery, the VAS score at rest reported by the patient in group Ⅰ was significantly higher than that in group Ⅱ （P 〈0.05） and that in group Ⅲ （P 〈0.01）, while the VAS score during coughing in group Ⅰ was higher than that in group Ⅱ and that in group Ⅲ （P 〈1.01）. Analgesic requirements in the first 24 h were （99±15） mL in group Ⅰ, （83±8） mL in group Ⅱ, and （78±9） mL in group Ⅲ, without significant difference among the groups. However, the analgesic requirement in the second 24 h was （81±10） mL in groupⅠ, much more than that in group Ⅱ （P 〈0.05） and in group Ⅲ （P 〈0.01）. The incidence of nausea, was significantly higher in group Ⅰ than in group Ⅲ. [Conclusion] The preoperative administration xafon before skin incision on patient-controlled epidural analgesia for postoperative pain relief compared with saline administration. Improves the postoperative pain management and reduces postoperative analgesic consumption and side effects.

关 键 词：疼痛 手术后 镇痛 硬膜外 非类固醇抗炎药(NSAIDS) 

分 类 号：R713.42[医药卫生—妇产科学]