术后患者自控硬膜外镇痛意外情况及处理

The problems and their treatment in postoperative PCEA

目的针对术后患者自控硬膜外镇痛(PCEA)中出现的意外情况,总结出相应的处理办法。方法选择ASA I-Ⅱ级,硬膜外麻醉效果满意的外科手术患者332例,术后保留硬膜外导管行PCEA。配方:芬太尼0．2 mg,布比卡因150 mg加生理盐水至100 ml。设置参数为:持续量2 ml/h,单次给药量2 ml,锁定时间15 min;PCEA泵均在术毕开机,维持2—7日。结果术后镇痛优良率97％,发现有意外情况的病例56例,占16．87％。结论对实施PCEA的医生应进行系统学习和训练;即时给患者和家属交待有关注意事项;完善PCEA术后随诊制度;加强PCEA装置的管理;出现异常情况应迅速处理。

Objective To observe the common problems in postoperative patient-controlled epidural analgesia（PCEA）and explore the treatment measures to deal with them. Methods Postoperative PCEA was performed in 332 patients undergoing general surgery operation with epidural anesthesia. After operation the patients received continuous 2 ml/h of 0.15% bupivacaine solution（with fentanyl 2 μg/ml, 2 ml of bolus dose and 15 min lock-out interval）for PCEA. Duration of PCEA was 2-7days after operation. Results The rate of excellent and good effect of PCEA was 97%. The problems happened in 56 cases （ 16.9% ）. Conclusion Some problems may frequently happen in postoperative PCEA. The measures to deal with the problems include training the doctors who administer PCEA,explaining how to operate PCEA pump to the patients and their relatives,perfecting the follow up system of PCEA,and immediately dealing with any abnormal events.