硬膜外与静脉PCA用于术后镇痛的效果评估  

Effective Evaluation of Epidural and Intravenous Patient-control Analgesia after Operation

作　　者：刘伟[1] 肖占元[1] 李立光[1] 

机构地区：[1]哈尔滨市第一医院麻醉科,黑龙江哈尔滨150010

出　　处：《黑龙江医学》2002年第10期742-744,共3页Heilongjiang Medical Journal

摘　　要：目的　比较硬膜外与静脉自控镇痛 (PCEA、PCIA)在术后镇痛中的临床效果。方法　 6 0例在硬膜外麻醉下行妇科手术患者 ,随机分为硬膜外注射吗啡病人自控镇痛 (PCEA)组和静脉注射吗啡病人自控镇痛(PCIA)组。PCEA组在手术结束时 ,经硬膜外导管注入负荷量 (吗啡 1mg + 0 9%生理盐水至 5ml) ,然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛 ,给药剂量每次吗啡 0 2mg ,锁定时间为 2 0min ;PCIA组在手术结束时静脉注入负荷量 (吗啡 0 5～ 1mg)然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛 ,给药剂量每次吗啡 1mg ,锁定时间为 5min。术后 4、8、12、2 4h进行观察 ,并记录吗啡用药量、疼痛评分 (VAPS)、平均动脉压、呼吸频率、镇静程度和恶心、呕吐等情况。结果　术后 2 4h用药总量PCIA组明显高于PCEA组 ;术后疼痛评分PCIA组在术后 4、8、12h高于PCEA组 ;PCIA组术后镇静程度明显高于PCEA组 ;PCIA组恶心、呕吐发生率及程度明显高于PCEA组 ;患者对术后镇痛总体满意度评估PCEA组略高于PCIA组 ,但无统计学差异 ;2组患者术后各时相呼吸频率及平均动脉压都在正常范围 ,且无统计学差异。结论　PCEA、PCIA均达到较好的镇痛效果 ,减轻术后应激反应。PCIA组恶心、呕吐发生率高 ,且易发生明显镇静。对于硬膜外麻醉?Objective To compare the effect of epidural and intravenous patient-control analgesia (PCEA and PCIA) after operation. Methods 60 obstetrics operation patients with injection morphine PCEA and PCIA were randomly divided into 2 groups. In group A: general anesthesia followed by postoperative patient-controlled analgesia (PCEA) with epidural morphine 0.2mg per 20 minutes after operation with load dosage 1mg morphine; In group B : general anesthesia followed by postoperative patient -controlled intravenous analgesia (PCIA) with morphine 1mg per 5 minutes after operation with load dosage 1mg morphine. Visual analog scale, mental status, MAP, RF and gastrointestinal function were measured in 4, 8, 12 and 24 hours after operation. Results The total dosage of morphine in PCIA group was higher that group A after 24 hours operation. In group B visual analog scale was high significantly in 4, 8, 12 hours postoperation compared with group A. The mobility and degree of nausea and vomiting in group B were higher than those in group A. The analgesia satisfactory degree in group A was higher and RF and MAP were similar normal with two groups without significant difference. Conclusion Both two methods could reach the better analgesia results to reduce the stress reaction postoperation. Themobility of nausea and vomiting in group B were higher and easy to be sedation in PCIA group. Patient-controlled epidural analgesia (PECA) might be better than PCIA for epidural anesthesia patient otherwise PCIA should be first choice.

关 键 词：硬膜外自控镇痛 静脉自控镇痛 效果评估 PCEA PCIA 

分 类 号：R614.42[医药卫生—麻醉学] R614.24[医药卫生—外科学]