患者自控镇静止痛在局麻眼底手术中的应用  

Application of patient controlled sedation-analgesia in fundus operation under local anesthesia

作　　者：李梅[1] 李天佐[1] 张炳熙[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《北京医学》2004年第1期49-51,共3页Beijing Medical Journal

摘　　要：目的　探讨局麻眼底手术患者应用异丙酚自控镇静止痛 (PCSA)的优越性。方法　择期局麻眼底手术患者 4 0例 ,随机分为PCSA组 (n =2 0 )和对照组 (n =2 0 )。PCSA组术中通过按压手柄的方法用韩国Automed2 30 0泵进行自控镇静止痛。药物配置 :异丙酚 2 0 0mg +芬太尼 0 .1mg为一单元 ,静脉注入。参数设定 :按异丙酚量计算 ,负荷量 0 .5mg/kg ,背景速度 0 .5mg·kg-1 ·h-1 ,单次按压剂量 2ml,锁定时间 3min ;对照组手术开始时即以异丙酚 +芬太尼 (配方同上 ) ,按异丙酚 5mg·kg-1 ·h-1 量持续泵入。观察项目 :手术开始 2 0min、1h、2h及术毕时刻 ,分别评定镇静评分 (OAA/S ,警觉 /镇静评分 )、患者合作评分 ,脑电双频指数 (BIS)、血压、心率、SO2 值。术毕询问患者的满意度 (VAS)。结果　PCSA组术中各点镇静评分及BIS值均低于对照组 ,合作评分及满意度均高于对照组 ;PCSA组异丙酚和芬太尼的用量低于对照组 ,而且在PCSA组中用药量个体差异较大。Objective To explore the advantage of patient controlled sedation analgesia(PCSA) by comparing with routine sedation with Propofol.Methods 40 patients were selected and randomly divided into two groups: PCSA group(patient controlled sedation analgesia group)(n=20) and control group(n=20).All patients were given Propofol and Fentanyl intraveinously.Patients in PCSA group used the Automed 2300 pump to control the sedation level by pressing the button themselves,while those in control group were injected by anesthetist.Propofol 200mg + Fentanyl 0.1mg were injected as one unit.In PCSA group,0.5mg/kg of Propofol as loading dose,0.5mg·kg -1 ·h -1 injected continuously as background speed and the locked time was 3 minutes;In control group,5mg·kg -1 ·h -1 of Propofol were injected continuously.OAAS,cooperation score,BIS were measured during the operation and satisfactory score were measured after the operation.Results OAAS and BIS in PCSA group were lower than control group;Cooperation score and satisfactory score in PCSA group were higher than control group.The consumption of Propofol and Fentanyl was less in PCSA group.Conclusions Patient controlled sedation analgesia is ideal way to control pain in patients with fundus operation.

关 键 词：自控镇静止痛 异丙酚 眼底手术 局部麻醉 芬太尼 心理效应 

分 类 号：R614[医药卫生—麻醉学]