食管癌术后两种镇痛模式的临床观察与护理  

Clinical observation and nursing in patients undergong two different mode of analgesia for esophageal cancer.

作　　者：蔡树云[1] 陈金仙[1] 余沛旭[1] 黄文君[1] 黄雪莲[1] 

机构地区：[1]广东医学院附属医院,524001

出　　处：《护理实践与研究》2010年第1期19-22,共4页Nursing Practice and Research

基　　金：湛江市科技攻关项目;编号:2009C3105003

摘　　要：目的:探讨舒芬太尼硬膜外与静脉持续镇痛用于食管癌三切口手术的镇痛效果及护理特点。方法:将50例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级行食管癌三切口手术的病人随机分为硬膜外镇痛组(E组,n=28例)和静脉镇痛组(Ⅰ组,n=22例)。记录术后6,12,24,48 h两组病人的静止和运动镇痛评分、副作用以及镇痛满意度整体评分,持续监测病人的血压、心率、血氧饱和度、呼吸频率。结果:术后两组病人的静止镇痛评分比较无明显差异,但运动镇痛评分在术后12,24 h时点疼痛评分比较E组优于I组(P<0.05);且术后镇痛满意度整体评分E组优于Ⅰ组(P<0.05);两组病人术后镇痛的副作用及不良反应发生率均较低,组间比较无明显差异(P>0.05);两组病人术后生命体征平稳,仅在术后6,12 h时点,I组的呼吸频率高于E组(P<0.05),有显著性差异。结论:舒芬太尼硬膜外镇痛用于食管癌术后镇痛,效果明显优于舒芬太尼持续静脉镇痛。护理上应做好针对性的护理干预和管理,以提高食管癌手术病人术后的生活质量。Objective ：To investigate the analgesic effect, side effects and nursing measurement of postoperative patient - controlled epidural analgesia compared to intravenous analgesia with sufentanil in patients undergoing three - incision surgery for esophageal cancer. Methods ：50 patients undergoing three - incision surgery for esophageal cancer were randomly divided into two groups：group E were received postoperative patient -controlled epidural analgesia（ n = 28 ）, and group I received postoperative patient - controlled intravenous analgesia （ n = 22 ）. Visual analogue scale （ VAS）, VAFS, satisfaction, sedation scores at rest and on movement,vital signs （MAP, HR, RR, SpO2 ） and side effects including nausea, emesis, pruritus and resperitory inhibition were assessod after 6,12,24 and 48 h of postoperative analgesia. Results：There were no significant difference between two groups in analgesic effects when patients in resting（ P 〉 0.05 ）, but the analgesic effect in group E was better than in group I when patients in coughing （ P 〈 0.05 ）. The scores of satisfaction of pestoperative analgesia were lower in group E than group I （P 〈 0.05 ）. The incidence of adverse events including side effects （nausea, pruritus and resperitory inhibition） was lower. Conclusion：The study suggests that continuous epidural analgesia with sufentanil provide a better treatment to postoperative pain than continuous intravenous analgesia. Analgesia management and nursing inervention can improve the life quality of the patients undergone esophagus carcinoma resection.

关 键 词：舒芬太尼 静脉 硬膜外 自控镇痛 食管癌 护理 

分 类 号：R473.73[医药卫生—护理学]