静脉与硬膜外泵注芬太尼患者自控镇痛的临床应用  

Evaluation of patient-controlled analgesia through intravenous or epidural infusion of fentanyl

作　　者：方永珍 丘小青 

机构地区：[1]福建省云霄县中医院麻醉科,福建云霄363300

出　　处：《海南医学院学报》2009年第9期1154-1156,1159,共4页Journal of Hainan Medical University

基　　金：海南医学院科研基金资助学报项目(0020090170)~~

摘　　要：目的:比较术后静脉和硬膜外应用芬太尼患者自控镇痛(PCA)的临床效果和安全性。方法:40例经腹子宫切除术患者随机分为静脉注射芬太尼自控镇痛(PCIA)组和经硬膜外注射芬太尼自控镇痛(PCEA)组,每组20例。两组芬太尼负荷量都是50μg。PCA药物配方为芬太尼1000μg+氟哌啶5mg+0.9%氯化钠至100mL。持续给药注速1mL/h,单次PCA剂量1mL,锁定时间15min。术后定时进行镇痛及镇静评分和患者满意度调查,观察48hPCA需求按压和有效按压次数,以及芬太尼用量和不良反应。结果:PCIA组48h内药物用量、需求按压和有效按压次数均明显少于PCEA组(P<0.05)。两组患者均可取得满意的镇痛和镇静效果,在PCA泵使用后12h内,PCIA组视觉模拟法(VAS)疼痛评分及Ramesay镇静评分与PCEA组有显著性差异(P<0.05)。两组不良反应发生率无明显差异。PCIA和PCEA组患者对术后镇痛的总体满意度分别为90%和85%。结论:ITP是一种免疫异常的血小板减少症,其发病与Hp感染关系密切,对初诊的ITP患者,建议在常规治疗基础上,进行正规抗Hp治疗。Objective： To investigate the effects and safety of patient-controlled analgesia （PCA） through intravenous or epidural infusion of fentanyl. Methods： Forty patients undergoing hysterectomy through abdomen were divided randomly into group A （ n = 20） and group B （ n = 20 ）, patients in group A underwent patient- controlled analgesia through intravenous infusion of fcntanyl （ PCIA）, patients in group B underwent patient-controlled analgesia through epidural infusion of fentanyl （PCEA）. Load dose of fentanyl in the two groups was all 50 μg. The prescription of PCA ： fentanyl 1000 μg ＋ droperidol 5 mg ＋ 0.9% sodium chloride to 100 mL. The speed of continued drug infusion was 1 mL·h-1 , a single dose of PCA was 1 mL, and lockout time was 15 min. Regular postoperative score of analgesia and sedation and survey of patients＇ satisfaction were carried out; times of demand compression and effective compression of the PCA device, fentanyl dose and side effects in 45h were observed. Results： Times of demand compression and effective compression of the PCA device, fentanyl dose between the two groups had significantly differences （P 〈 0.05 ）, and all patients in the two groups acquired satisfactory analgesia and sedation; compared group A with group B for pain with visual analogue score （VAS） and sedation with Ramesay score, the differences were significant （ P 〈 0.05 ） ; differences of the side effects incidence be- tween the two groups were significant （ P 〉 0.05 ） ; the overall satisfactory rate of analgesic and sedative effect in group A and B was 90% and 85% respectively. Conclusion： The fentanyl for postoperative analgesia is safe and effective, and the effect of PCIA is better than PCEA..

关 键 词：芬太尼 镇痛 病人控制 子宫切除术 

分 类 号：R971.2[医药卫生—药品]