硬膜外自控镇痛对腹部手术后止痛作用的临床研究

Clinical research of epidural self-deliberate analgesia to the influence on the pain after abdominal operation

目的探讨硬膜外病人自控镇痛（PCA）对腹部手术后的止痛效果。方法对2003年1月至12月病情分级（ASA）Ⅰ～Ⅱ级腹部手术100例病人，随机分为硬膜外病人自控镇痛（PCA）（P组）50例，硬膜外吗啡组（M组）25例，空白对照组（E组）25例。分析比较三组手术前后病人的平均动脉压（MAP）、心率（HR）、动脉血氧饱和度（SaO2）及模糊评分法（VAS）评分的变化。同时比较三组病人发生恶心、呕吐、皮肤瘙痒、尿潴留、排气延迟、肢体麻木和活动受限等不良反应的发生情况。结果三组病人的MAP、HR、SaO2，在镇痛前后均无显著变化（P〉0．05）。镇痛效果和不良反应的发生三组间差异有显著性（P〈0．05）。结论PCA对腹部手术后疼痛的治疗方法安全、疗效确切，是值得推广应用的术后镇痛技术。

Objective To investigate the epidural self-deliberate analgesia to the influence on the pain after abdominal operation. Methods In this study, we selected 100 cases from the patients with abdominal operations in ASA （American Society of Anesthesiologists） Ⅰ - Ⅱ grade since 2003.1 to 2003.12. Among them, there were 15 male and 85 female. They were randomly divided into three groups. One was group of epidural self-deliberate analgesia （PCA, Group P）, 50 cases in total; the other was group of epidural morphine （Group M）, 25 cases in total; and the last was the control group （Group E） in which the patients hadn＇t any measures to ease the pain after abdominal operations. Variation of Mean Arterial Pressure （MAP）, Heart Rate （HR）, SPO2 and VAS score before and after the operation were analyzed and compared among the patients in the three groups. Moreover, we compared the occurrence of the complications such as nausea, vomiting, skin scratch, urinary retention, delay of wind, limb numbness, limitation of activity and so on between the three groups. Ruselts The MAP, HR, SPO2 of all the patients in Group P, Group M and Group E were not significantly different before and after the analgesia （P〉0.05）. But there were significantly different in the effect of analgesia and the occurrence of those complications among the three groups （P〈0.05）. Conclusions Epidural self-deliberate analgesia was a safe and effective therapy to ease the pain after abdominal operation, and which is an analgesic technique worthy to be popularized after operation.