病人自控硬膜外镇痛用于妇科术后的效果观察  

The Effects of Postoperative Patient-controlled Epidurual Analgesia with Morphine and Bupivacaie after Hysterectomy:a Comparison with Intramuscular Analgesia

作　　者：卢光临[1] 魏红云[1] 景龙年[1] 

机构地区：[1]潍坊医学院附属医院,山东潍坊261041

出　　处：《潍坊医学院学报》2003年第3期209-211,共3页Acta Academiae Medicinae Weifang

摘　　要：目的　比较子宫全切术后病人自控硬膜外镇痛 (PCEA)与传统肌注哌替啶法镇痛效果及对应激反应的影响。方法　子宫全切手术 80例 ,随机分为术后病人自控硬膜外镇痛 (PCEA)组 (Ⅰ组 ,4 0例 ) ,肌注哌替啶组 (Ⅱ组 ,4 0例 )。Ⅰ组术毕用 0 .15 %布比卡因 + 0 .0 0 5 %吗啡 +氟哌利多 5mg行PCEA ,Ⅱ组术后疼痛时肌注哌替啶。结果　两组呼吸循环平稳 ,Ⅰ组术后 6h ,2 4h视觉模拟评分 (VAS)低于Ⅱ组 (P <0 .0 1) ,术后 6h ,2 4h血浆皮质醇亦明显低于Ⅱ组 (P <0 .0 5 ) ,患者满意度高。恶心、呕吐等副作用Ⅰ组低于Ⅱ组 (P <0 .0 1)。结论　妇科术后低浓度布比卡因复合小剂量吗啡行PCEA ,镇痛完善 ,能有效抑制机体应激反应 。Objective To compare the clinical effects and stress responses of epidural PCA with intramuscular injection pethedine for patients after gynecologic operations.Methods Eighty patients undergoing hysterectomy under epidural anesthesia were randomly divided into two groups:PCEA group(n=40) and intramuscular analgesia (IM) group (n=40).The epidural catheter was inserted between L 1 and L 2 with the epidural block level betweenT6 and S5.The mixture of 0.15% bupivacaine and 0.005% morphine combined with 0.005% droperidol was administed postoperatively for PCEA by a infusion system with loading dose of 6ml,PCA dose of 0.5ml and lockout time of 15min in group PCEA,and in group IM intramuscular pethedine 1mg·kg -1 was given intermittently for postoperative analgesia.The analgesic and side effects were recorded.Blood pressure,heart rate,respiratory rate and pulse oxygen saturation were monitored for 24h postoperatively.Results In PCEA group the score of visual analog scale was significantly lower than that in group IM (P<0.01) and serum cortisol level decreased markedly in PCEA group (P<0.05).Blood pressure (BP),heart rate (HR),respiratory rate (RR),and SpO 2 remained steady all the time in both groups.The incidence of nausea and vomiting was obviously higher in group IM than that in group PCEA(P<0.01).Conclusion PCEA after gynecologic operation with morphine and bupivacaine can provide better pain relief and inhibit postoperative stress more effectively than intramuscular injection of pethedine intermittently.

关 键 词：疼痛 术后 麻醉 硬膜外 吗啡 镇痛 

分 类 号：R614.2[医药卫生—麻醉学]