手术后硬膜外自控镇痛时三种镇痛药临床效果比较

Comparison of Clinical Analgesic Effect Among Three Narcotics in Postoperative Controlled Epidural Analgesia

为比较手术后硬膜外自控镇痛（PCEA）时等效剂量吗啡、芬太尼或哌啶的镇痛效果及不良反应，按镇痛药将患者随机分成三组，每组20例。镇痛药液为0.1％布哈卡因40ml中加入芬太尼0.1mg（Ⅰ组）、吗啡10mg（Ⅱ组）或哌替啶100mg（Ⅲ组）。患者感到手术创口疼痛时自行撤压PCEA泵的自控按钮。结果显示48小时镇痛药液累积用量Ⅰ组和Ⅲ组是Ⅱ组的3倍;Ⅱ组镇痛效果达优者比Ⅲ组多。镇痛治疗期间平均压、脉卒和呼吸率与麻醉前比较均无明显差异，SpO2都保持在95％以上。Ⅲ组恶心发生率高于Ⅲ组;仅Ⅱ组发生皮肤瘙痒;三组尿储留发生率分别为57.1％、400％和30.7％。结论：用低浓度布吡卡因和麻醉性镇痛药复合液行PCEA能获得良好的术后镇痛效果，对呼吸循环功能无明显影响。吗啡镇痛复合液用量最少，效果最好。

The aim of this study was to compare analgesic effect and side-effect between morphine,fentanyl and pethidine in equivalent dose with 0. 1 % bupivacaine during postoperative controlled epidural analgesic (PCEA). Sixty adult patients undergoing abdominal or lower extremity operation in epidural anesthesia were treated with PCEA pump postoperatively. All patients were randomly divided into three groups according their narcotics used,twenty in each. The analgesic solution were contained fentanl 0. 1 mg (group Ⅰ ),morphine 10mg (group Ⅱ )or pethidine 100mg (group Ⅲ ) in 0.1 % bupivacaine 40ml,respectively. When the patient felt pain postopartively,he could push down the button of PCEA pump by himself. The locking time of PCEA was 15 min.The result revealed that accumulation dosage of analgesic solution during in group Ⅰ and Ⅲ were three times than group Ⅲ, In analgesic effect evaluation, the cases of excellence were more in group Ⅱ than in group Ⅲ 。 MAP,pulse rate and respiratory rate were no significant change in all groups. SPO2 was maintained over 95% in all groups. The incidence of nausea in group Ⅱ was higher than group Ⅲ. Only some patients in group Ⅲ complained skin itching. The incidence of urinary retenti0n was 57. 1 %,40. 0% and 30. 7% in groupⅠ,Ⅱ andⅢ,respectively. It is concluded that lower concentration of bupivacatine and narcotics compound solution could be used for postoperatively analgesia with good analgesic effect,and no significant influence on cardio-respiratory function. It seems the morphine is better than fentanyl and pithedine.