PCIA与PCEA对下腹部手术后患者功能恢复影响的对比研究

A comparative study: effects of PCIA and PCEA on functional recovery in patients after hypogastric operation

目的比较静脉自控镇痛(PCIA)与硬膜外镇痛(PCEA)对下腹部手术后患者胃肠道功能及功能性运动能力恢复的影响。方法选择期胃肠道肿瘤手术患者26例,按术后镇痛方式分为两组:I组(n=14)术后PCIA,E组(n=12)术后PCEA。于术前、术后2周和4周观察功能性运动能力(6min行走试验,6MWT),住院期间观察胃肠道功能(首次排气和排便时间、恶心呕吐发生率)以及镇痛情况。结果与术前相比,术后2周6MWT呈显著减退(P<0.05),术后4周基本恢复至术前水平,各时点两组间比较差异无统计学意义;胃肠道功能的恢复E组快于I组(P<0.05)。结论静脉自控镇痛与硬膜外镇痛对胃肠道手术后患者功能性运动能力恢复的影响相似,但与静脉自控镇痛(PCIA)比较,硬膜外术后镇痛可促进胃肠道功能的恢复。

Objective To compare the effects of patient-controlled intravenous analgesia （PCIA） and patient-controlled epidural analgesia（PCEA） on the recovery of gastrointestinal function and functional motor ability of patients after operation on hypogastric region. Methods Twenty-six patients scheduled for selective gastrointestinal surgery were divided into 2 groups： group Ⅰ （ n = 14） receiving PCIA after operation, and group E （ n = 12） receiving PCEA after operation. Functional motor ability （6 min walking test, 6MWT） was measured before and after operation for 2 weeks and 4 weeks. Gastrointestinal function （onset time of postoperative exhaust and defecation, incidence of nausea and vomiting during 3 d after operation） and effect of analgesia were recorded. Results Compared with pre-operation, 6 min walking test（6MWT） declined significantly at week 2 after operation （P〈0,05）, and recovered at week 4 after operation. 6MWT had no significant difference between 2 groups, The recovery of gastrointestinal function in group E was faster than in group I （P 〈 0.05）. Conclusion The effects of PCEA and PCIA on the recovery of functional motor ability of patients after gastrointestinal surgery are similar, However, PCEA could promote the recovery of gastrointestinal function compared with the PCIA