静脉与硬膜外自控镇痛对妇产科术后患者恶心、呕吐的影响

Comparison of the Effect of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Postoperative Nausea and Vomit In Gynecologic and Obstetric Patients

目的比较妇产科术后静脉自控镇痛（PCIA）与硬膜外自控镇痛（PCEA）的镇痛效果及对恶心、呕吐等副作用的影响。方法56例ASAⅠ～Ⅱ级妇产科手术患者随机分为三组：PCIA组（n=18），镇痛用药为吗啡1mg／ml＋氟哌利多0．1mg／ml；PCEA—Ⅰ组（n=19），镇痛用药为吗啡0．1mg／ml＋0．125％布比卡因；PCEA-Ⅱ组（n=19），镇痛用药为吗啡0．1mg／ml＋0．125％布比卡因＋氟哌利多0．1mg／ml。术后4h、24h、48h分别记录患者视觉模拟疼痛评分（VAS）、RameSay镇静评分以及恶心、呕吐、皮肤瘙痒、呼吸抑制、低血压、下肢麻木及运动障碍等不良反应。结果两组PCEA患者的VAS评分明显低于PCIA组（P〈0．01）；术后4～24h，PCEA-Ⅱ组恶心、呕吐的发生率低于PCIA组（P〈0．05），术后追加镇痛、镇吐药的人数也少于PCIA组（P〈0．05）。三组患者皮肤瘙痒、过度镇静等PCA相关并发症的发生率相似（P〉0．05）。结论PCEA镇痛效果良好，硬膜外持续应用氟哌利多可有效减少术后恶心、呕吐的发生，是妇产科术后镇痛的较好选择。

Objective To compare the effects of patient-controlled epidural analgesia （PCEA） and patient-controlled intravenous analgesia （PCIA） on postoperative nausea and vomit （PONV） in gynecologic and obstetric patients. Methods 56 gynecologic or obstetric patients （ASA Ⅰ～Ⅱ ） scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0. 1 mg/ml droperidol intravenously （group PCIA） or 0.1 mg/ml morphine plus 0. 125% bupivacaine （group PCEA- Ⅰ ） or 0.1 mg/ml morphine plus 0. 1 mg/ml droperidol plus 0. 125 % bupivacaine （group PCEA- Ⅱ） epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale （VAS）, sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. Results VAS scores in the two PCEA groups were much lower than that of PCIA （P〈0. 01）. The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group （P〈0.05）, incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups （P〉0. 05）. Conclusion The regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.