摘要
目的:比较术后静脉注射吗啡病人自控镇痛与硬膜外吗啡镇痛的临床效果和安全性。方法:60例在硬膜外麻醉下行妇科手术的患者随机分为硬膜外吗啡镇痛(EPI)组和静脉注射吗啡病人自控镇痛(PCIA)组。EPI组在手术结束时经硬膜外导管一次性注入吗啡2mg,PCIA组在术后患者感觉到疼痛时。自行给药镇痛,给药剂量每次1mg,锁定时间为5分钟。术后4、8、12、24小时进行随访并记录吗啡用药量、疼痛评分(VAPS)、平均动脉压和呼吸频率、镇静程度及恶心、呕吐等副作用情况。结果:术后24小时用药总量PCIA组(19.1±5.1mg)明显高于EPI组(2mg)。术后0～12小时EPI组镇痛效果优于PCIA组,镇静程度PCIA组高于EPI组。PCIA组恶心、呕吐发生率均高于EPI组,皮肤瘙痒EPI组2例,PCIA组1例。两组患者对术后镇痛总体满意度评估良好至优秀者百分率无显著性差异。两组患者术后呼吸频率及平均动脉压均在正常范围。结论:对于硬膜外麻醉术后需短期镇痛患者,单次剂量硬膜外吗啡镇痛效果优于PCIA组,副作用较少。
Objective: To compare the efficacy and side effects of patient-controlled intravenous morphine with epidural single bolus morphine in postoperative pain relief. Method: Sixty patients undergoing gynecological procedures under epidural anesthesia were randomly assigned to epidural morphine(EPI)group or patient-controlled intravenous analgesia (PCIA) group. In the EPI group,2 mg of morphine was injected into epidural space at the end of operation. In PCIA group, 1 mg of morphine as a demand dose would be injected intravenously by the patient through a patientcontrolled analgesic delivery system until the pain relieved. The patients were followed up at 4, 8, 12, 24 h after operation,and the degree of pain,sedation, nausea and vomiting were assessed. Result: The total dosage of morphine was higher in the PCIA group(19.08±5.0 mg)than that in the EPI group(2mg,P<0.01). At the interval of 0 to 12 h following surgery,the pain scores were higher in the PCIA group. The degree of sedation and the incidences of nausea and vomiting were also higher in the PCIA group than those in the EPI group. There were one and two patients suffering from pruritus in PCIA and EPI groups respectively. There was no significant difference between the two groups in the overall satisfaction of pain relief. The postoperative respiratory rates and mean blood pressure were within the normal ranges. Conclusion: The pain relief is better by single dose of epidural morphine with less side effects for patients who required short term analgesia
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1997年第9期553-556,共4页
Chinese Journal of Anesthesiology
关键词
镇痛
病人自控镇痛
硬膜外
吗啡
Analgesia,patient-controlled
Epidural
Morphine
