回顾性分析1152例术后静脉自控镇痛效果  

A retrospective analysis of 1152 cases of post-operative intravenous patient control analgesia

作　　者：裴丽坚[1] 桑诺尔[1] 高鲜丽 夏伟鹏 徐梅 张秀华[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医院麻醉科,北京100730 [2]深圳市卫生局,广东深圳518020 [3]中国医学科学院整形外科医院麻醉科,北京100041 [4]中国医学科学院北京协和医院麻醉科手术室,北京100730

出　　处：《基础医学与临床》2013年第12期1614-1618,共5页Basic and Clinical Medicine

摘　　要：目的评价静脉自控镇痛技术的临床疗效。方法对2012-01-01—06-30北京协和医院外科住院患者术后行静脉自控镇痛效果进行回顾性分析。结果不同手术类型(下腹部/盆腔手术、上腹部手术、胸部手术和骨科手术)术后静息疼痛视觉模拟评分(VAS)最大值无统计学差异;术后活动后疼痛VAS评分最大值有统计学差异(P<0.05),胸部>上腹部、骨科>下腹部/盆腔手术;术后镇静评分有统计学差异(P<0.001),骨科术后镇静评分较高。不同患者静脉自控镇痛方法(吗啡、芬太尼、舒芬太尼、非甾类抗炎药和阿片类药物+非甾类抗炎药)术后静息疼痛VAS评分最大值、术后活动后疼痛VAS评分最大值、术后镇静评分均无统计学差异。结论术后静脉自控镇痛效果与国外研究结果相当。单纯通过不同药物配伍改进镇痛效果,疗效有限。胸部、上腹部和骨科手术活动后疼痛控制较差,骨科术后镇静评分较高,尚待解决。Objective To evaluate the efficacy of intravenous patient control analgesia in one center. Methods Data of surgical inpatients in PUMC Hospital from January 1st to June 30th, 2012 were analyzed. Results The maximum VAS score of postoperative pain at rest of different procedure （ lower abdomen/pelvis, upper abdomen, thoracic and orthopedic） had no significant difference, the maximum VAS score of post operative pain during move- ment were significantly different （ P 〈 0. 05 ） , thoracic 〉 upper abdomen, orthopedic 〉 lower abdomen. Postoper- ative sedation scores were significantly different （P 〈 0. 001 ） , sedation scores of orthopedic patients was much higher. The maximum VAS score of postoperative pain at rest, during movement between morphine, fentanyl, sufentanil, non-steroidal anti-inflammatory drugs and opioids ＋ non-steroidal anti-inflammatory drugs were no sig- nificant different. Postoperative sedation scores were no different. Conclusions The efficacy of intravenous patient control analgesia in PUMC Hospital was similar to that reported in literutures. Poor pain control during movement,especially in thoracic, upper abdomen and orthopedic procedure. Sedation score of orthopedic procedure was much higher. Different opioids or combined with non-steroidal anti-inflammatory drugs may not improve clinical practice.

关 键 词：静脉自控镇痛技术 视觉模拟评分 

分 类 号：R614.27[医药卫生—麻醉学]