影响病人静脉芬太尼自控镇痛相关因素分析

Study of Correlative Factors on Patient-controlled Intravenous Anesthesia after Lower Limb Operation

目的 分析影响病人芬太尼静脉自控镇痛 (PCIA)的因素,提高术后镇痛的效果。方法 选择 60例ASA Ⅱ级实施下肢手术硬膜外麻醉病人,术后停止硬膜外给药,静脉负荷量为芬太尼 0. 1mg,接镇痛泵,镇痛液含 1mg芬太尼用生理盐水配成 100mg,背景输注量为2ml/h,指令剂量为 0. 5ml/次,锁定时间为 15min,分析手术类型、年龄、体质量和手术时间对镇痛效果的影响。以术后疼痛评分、镇静评分、PCIA按压次数、辅助镇痛药和病人呼吸次数、血压、心率、SPO2 及术后并发症评价镇痛的效果。结果 术后 24h时小手术的VAS评分低;大手术、年龄 <45岁,体质量 >70kg以上VAS评分高,PCIA按压次数多,辅助镇痛药多,不同性别,手术时间,硬膜外停药时间对病人术后VAS无明显影响。结论 手术的大小、病人的年龄和体质量是术后PCIA的影响因素,而性别和手术时间对术后PCIA无显著的影响。

Objective To analyze the factors correlative to patient-controlled intravenous anesthesia (PCIA) by infusing fentanyl so as to improve the postoperatively pain relief. Methods Sixty patients (ASA Ⅰ~Ⅱ), aging from 20~75 years and undergoing lower limb operation under epidural anesthesia, were enrolled into the study. The loading dose of fentanyl was 0.1mg. Fentanyl (1 mg) was mixed to normal saline (100 ml) for PCIA. The patient-controlled anesthetic device was set at 2 ml/h of background infusion, 0.5 ml of bolus, and 15 min of lockout time. Results Minor operation had lower VAS score; while higher score and more PCIA press times existed and more accessorial sedatives were given in those who were performed major operation and who were younger than 45 years old and heavier than 70 kg. No clear influence on VAS score were found in age and operative duration. Conclusion The operative type (minor or major), age and weight are the factors that have influences on PCIA, and sex and operative duration are not.