乳腺癌根治术后病人自控静脉吗啡与硬膜外吗啡镇痛的比较  

COMPARISON OF INTRAVENOUS AND EPIDURAL PATIENT CONTROLLED MORPHINE ANALGESIA AFTER BREAST CARCINOMA RADICAL OPERATION

作　　者：孙来保[1] 夏杰华[1] 房洁喻[1] 肖亮灿[1] 黄文起[1] 

机构地区：[1]广州中山医科大学附属第一医院麻醉科,广州510080

出　　处：《中国疼痛医学杂志》2000年第1期27-30,共4页Chinese Journal of Pain Medicine

摘　　要：目的 :比较乳腺癌根治术后病人自控静脉吗啡镇痛 (PCIA)和病人自控硬膜外吗啡镇痛 (PCEA)的效果。方法 :40例ASAⅠ～Ⅱ级行择期乳腺癌根治手术女性病人 ,术前随机分为PCIA和PCEA组 ,每组各 2 0例。全部病人采用气管内插管静吸复合全麻手术 ,PCEA组病人术前作硬膜外穿刺置管备术后镇痛。PCIA组用药术毕首量生理盐水 4ml+ 2mg吗啡 ,以后生理盐水 1 .5ml ( 0 .45mg吗啡 ) /h +PCIA生理盐水 4ml ( 1 .2mg吗啡 ) ;PCEA组术毕硬膜外用药首量类同PCIA组 ,以后生理盐水1 .5ml ( 0 .2 2 5mg吗啡 ) /h +PCEA生理盐水 4ml ( 0 .6mg吗啡 ) ,应用电脑镇痛泵治疗 ,锁定时间 5～ 1 0min ,维持术后镇痛 48h。记录镇痛镇静效果、病人满意度、副作用及术后肛门排气时间等。结果 :PCEA镇痛效果优于PCIA病人 (P <0 .0 5 ) ,而PCIA术后 1 2h镇静程度强于PCEA病人 (P <0 .0 5 ) ;PCEA组病人吗啡用量明显减少 (P <0 .0 1 ) ;PCEA尿潴留明显多于PCIA病人 (P <0 .0 1 ) ,术后胃肠功能恢复两组病人相同 (P >0 .0 5 ) ;两组病人术后镇痛满意度相同 ,优良率达 90 % (P >0 .0 5 )。结论 :两种镇痛方法都可以满足临床需要 ,但各有优缺点 ,PCEA镇痛效果较好 ,而尿潴留发生较多 。Objective: Comparing the efficacy and side effects of intravenous patient controlled morphine analgesia(PCIA) with epidural patient controlled morphine analgesia(PCEA). Methods: 40 ASA Ⅰ～Ⅱ class patients after breast cancinoma radical operation were randomly divided into two equal groups. PCIA group received loading dose of saline 4ml containing morphine 2mg, then infusion of saline 1.5ml containing morphine 0.45mg/h plus PCIA of 4ml containing morphine 1.2mg; PCEA group received loading dose as PCIA, then infusion of saline 1.5ml containing morphine 0.225mg/h plus PCEA of 4ml containing morphine 0.6mg. Lockout time was 5～10 min. The analgesia was maintained for 48h. VAS pain scores, patient satisfaction, sedation scores, morphine dose, side effects and intestinal function recovery were observed and recorded. Results: VAS pain scores were lower in PCEA group than in PCIA group(P<0.05). Patient satisfaction had a similar score(P>0.05). Sedation scores were higher in the PCIA group than in PCEA group 12h after operation(P<0.01). PCEA group used significantly less morphine(P<0.01). Incidence of urinary retention was higher in PCEA group than in PCIA group(P<0.01). There were no differences in intestinal function recovery (P>0.05). Conclusion: Both PCIA and PCEA have their own advantages and shortcomings, remain clinically acceptable.

关 键 词：乳腺癌 自控镇痛 吗啡 硬膜外麻醉 

分 类 号：R614[医药卫生—麻醉学]