程序化间歇单次输注与持续输注模式下阿片类药物在妇科患者术后镇痛的效果比较  

Comparison of the analgesic effect of opioids in gynecological patients after operation under the mode of programmed intermittent bolus infusion and continuous infusion

作　　者：黄璜 杨静[1] 李萌萌[1] Huang Huang;Yang Jing;Li Mengmeng(Department of Anesthesiology,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心麻醉科,北京100048

出　　处：《中国医刊》2021年第9期1002-1005,共4页Chinese Journal of Medicine

基　　金：国家自然科学基金(81272030);吴阶平医学基金会临床科研专项资助基金(320.6750.13220);解放军总医院临床科研扶持基金三○四专项(2018FC-304Z-CXYY-01)。

摘　　要：目的探讨妇科患者术后程序化间歇单次输注(programmed intermittent bolus infusion,PIBI)与持续输注(continuous infusion,CI)阿片类药物的镇痛效果及不良反应。方法选取2019年10月至2020年2月于解放军总医院第四医学中心进行妇科手术的73例患者为研究对象,根据术后患者自控镇痛(patient controlled analgesia,PCA)模式不同分为PIBI组(34例)和CI组(39例)。比较分析两组患者术毕、术后30min、3h、24h、48h和72h的静息状态和躯体活动时的视觉模拟评分法(visual analogue scale,VAS)评分、PCA药物消耗量,记录两组患者术后不良反应发生情况。结果术毕、术后3h、24h、72h,两组患者静息状态和躯体活动时的VAS评分比较差异均无显著性(P>0.05);术后30min、48h,CI组患者静息状态和躯体活动时的VAS评分均显著高于PIBI组(P<0.05)。术后30min,两组患者的PCA药物消耗量比较差异无显著性(P>0.05);术后3h、24h、48h、72h,PIBI组患者的PCA药物消耗量均显著低于CI组(P<0.05)。两组患者头痛、嗜睡的发生率比较差异均无显著性(P>0.05);PIBI组患者术后恶心、呕吐的发生率均显著低于CI组(P<0.05)。结论与机械泵CI模式比较,妇科患者术后应用电子泵PIBI模式能为患者提供更显著的镇痛效果,且用药量更少,恶心、呕吐的不良反应发生率明显降低。Objective To investigate the analgesic effect and adverse reactions of programmed intermittent bolus infusion(PIBI)and continuous infusion(CI)opioids in gynecological patients after operation.Method 73 patients who underwent gynecological surgery in the Fourth Medical Center of Chinese PLA General Hospital from October 2019 to February 2020 were included.They were divided into PIBI group(34 cases)and CI group(39 cases)according to different postoperative patient controlled analgesia(PCA)modes.The visual analogue scale(VAS)score and PCA drug consumption at the end of operation,30min,3h,24h,48h and 72h after operation were compared between the two groups.The incidence of postoperative adverse reactions were recorded.Result There was no significant difference in VAS scores between the two groups at the end of operation,3h,24h and 72h after operation(P>0.05);At 30min and 48h after operation,the VAS scores of CI group were significantly higher than PIBI group(P<0.05).There was no significant difference in PCA drug consumption between the two groups 30 minutes after operation(P>0.05).At 3h,24h,48h and 72h after operation,the PCA drug consumption of PIBI group was significantly lower than CI group(P<0.05).There was no significant difference in the incidence of headache and drowsiness between PIBI group and CI group(P>0.05).The incidence of postoperative nausea and vomiting in PIBI group was significantly lower than that in CI group(P<0.05).Conclusion Compared with CI,the PIBI in postoperative intravenous controlled analgesia for gynecological patients can provide more significant analgesic effect,and the dosage is less,and the incidence of adverse reactions of nausea and vomiting is significantly reduced.

关 键 词：程序化间歇单次输注 持续输注 术后患者自控镇痛 视觉模拟评分法 

分 类 号：R614[医药卫生—麻醉学]