多联数字评分量表在开胸术后患者自控静脉镇痛方案中的应用  

Application of multi-scale digital scoring scale in patient-controlled intravenous analgesia after thoracotomy

作　　者：秦雪 刘娟 鲁开智 王莉[1] QIN Xue;LIU Juan;LU Kaizhi;WANG Li(Department of Anesthesiology,First Affiliated Hospital,Army Medical University（Third Military Medical University）,Chongqing,400038,Chin)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆400038

出　　处：《第三军医大学学报》2018年第16期1518-1522,共5页Journal of Third Military Medical University

摘　　要：目的评价多联数字评分量表在开胸手术术后患者自控静脉镇痛方案中的应用价值。方法择期行开胸手术患者74例,采用随机数字表法分为多联数字评分量表组(M组)和对照组2组(n=37)。M组:患者离开手术室转送到监护病房前及术后每2小时根据多联视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分、BCS(bruggrmann comfort scale)舒适评分、恶心及呕吐评分量表、呼吸抑制程度对患者进行综合评分,根据评分结果调整患者自控镇痛(patient controlled analgesia,PCA)的持续剂量和单次加强剂量;对照组:按照预设的持续给药剂量和单次PCA剂量实施术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA),剂量不予调整。两组PCIA的预设镇痛方案为:舒芬太尼300μg+氟比洛芬酯200 mg+托烷司琼15 mg,用0.9%生理盐水稀释至300 m L持续泵注,持续给药剂量3 m L/h,单次PCA剂量2 m L,锁定时间15 min。观察并记录患者术后2、4、8、24 h和48 h的静息和运动VAS评分、Ramsay镇静评分、BCS舒适评分和不良反应发生率,术后48 h PCA的总共消耗量、PCA的有效按压次数、患者总体满意度评分。结果与对照组比较,术后各个观察时间点M组的静息VAS评分差异无统计学意义(P>0.05),M组的PCA有效按压次数显著降低(P<0.05);M组术后2 h和4 h运动VAS评分明显降低,术后2、4 h和8 h BCS舒适评分明显升高(P<0.05);M组术后2 h Ramsay镇静评分明显升高,术后48 h Ramsay镇静评分明显降低(P<0.05);M组术后2 h PCA消耗量明显增加(P<0.05),术后4、8、24、48 h消耗量明显降低(P<0.05),M组总体满意度明显升高(P<0.05)。术后48 h两组患者不良反应发生率差异无统计学意义(P>0.05),对照组发生2例呼吸抑制,2例眩晕和3例恶心、呕吐,M组发生3例眩晕和2例恶心、呕吐。两组均无患者出现皮肤瘙痒。结论与单纯PCIA相比,多联数字评分量表指导实施的PCIA能够更加安全有效地应�Objective To assess the application of multi-scale digital scoring scale in patientcontrolled intravenous analgesia（ PCIA） after thoracotomy. Methods Seventy-four patients undergoing elective thoracotomy were equally randomized into control group and multi-scale digital scoring scale group（ group M）. In group M,Visual Analog Scale（ VAS）,Ramsay sedation score,Bruggrmann comfort scale（ BCS）,nausea and vomiting scale and the degree of respiratory depression were evaluated before the patients were transferred to the intensive care unit and every 2 h after the surgery,and the maintenance dose and single dose for PCIA were adjusted based on the results of the evaluations. In the control group,PCIA was administered at the preset maintenance dose and single dose without dose adjustment. The default PCIA formulation included sufentanil（ 300 μg）,flurbiprofen axetil（ 200 mg）,and tropisetron（ 15 mg）,all diluted in 300 m L normal saline for continuous pump infusion at 3 m L/h with a single dose of 2 m L and a lock time of15 min. At 2,4,8,24 and 48 h after the surgery,the VAS score,Ramsay sedation score,and Bruggrmann comfort scale were evaluated for each patient and the incidences of adverse reactions were recorded. At each of these selected observation points,analgesic consumption and the number of times of button presses were recorded,and the overall satisfaction of the patients was assessed. Results No significant difference was found in resting VAS score between the 2 groups at each of the observation points（ P〉0. 05）. Compared with the control group,group M had significantly lower times of button presses during PCIA（ P〈0. 05）,significantly lower VAS scores during exercise at 2 and 4 h,and significantly higher BCS scores at 2,4 and8 h（ P〈0. 05）. The Ramsay sedation score was significantly higher at 2 h but was lower at 48 h in group M than in the control group（ P〈0. 05）. Compared with that in the control group,analgesic consumption at 2 h was significantly increased（

关 键 词：数字评分量表 术后镇痛 开胸手术 

分 类 号：R614[医药卫生—麻醉学] R619[医药卫生—外科学]