术后静脉病人自控镇痛(PCIA)的临床应用与研究

Combination of patient controlled analgesia and continuous background intravenous infusion with narcotics for postoperative pain,a randomized double blind study

目的：评价连续基础静脉注射（ＣＢＩ）加静脉病人自控镇痛方法（ＰＣＡ）用于术后镇痛的效应。方法：３２０例ＡＳＡⅠ～Ⅱ级病人术后按ＣＢＩ速率分为四组，Ⅰ组：０．５ｍｌ·ｈ－１；Ⅱ组：１．０ｍｌ·ｈ－１；Ⅲ组：１．５ｍｌ·ｈ－１及Ⅳ组：２．０ｍｌ·ｈ－１。ＰＣＡ指标设置：锁定时间５分钟，ＰＣＡ剂量１．０ｍｌ，负荷剂量为３～５ｍｌ，所用药液为每毫升含１０μｇ芬太尼及０．１ｍｇ氟哌利多混合液。观察期为术后２４小时。结果：镇痛所用药物总剂量四组间无明显差异（Ｐ＞０．０５）。Ⅳ组的ＶＡＳ评分及ＰＣＡ使用次数均为０。与Ⅰ组相比，Ⅱ组及Ⅲ组的ＶＡＳ评分、Ｒａｍｓａｙ评分均明显降低（Ｐ＜０．０５），ＰＣＡ使用次数／无效次数的比值显著升高（Ｐ＜０．０５），但Ⅱ组与Ⅲ组相比，以上指标均无显著性差异。病人的血流动力学及呼吸功能保持平稳，未见其它副反应。结论：采用ＣＢＩ加ＰＣＡ方法静脉注射以上混合液用于术后镇痛安全有效，以芬太尼的负荷量、ＣＢＩ量和ＰＣＡ剂量分别设置为３０～５０μｇ、１０～１５μｇ·ｈ－１和１０μｇ，ＰＣＡ锁定时间设为５分钟更为合理。

Objective:To assess the analgesic effect of patient controlled analgsia (PCA) combined with continuous background intravenous narcotic infusion (CBI) for postoperative pain Method:The administrative mixture of narcotics per ml contained 10 μg fentanyl and 0 1mg droperidol After surgery,320 patients ASA grade Ⅰ Ⅱ,were randomly divided into four groups according to the rate of CBI,group Ⅰ:0 5ml·h -1 ,group Ⅱ:1 0ml·h -1 ,group Ⅲ:1 5ml·h -1 ,group Ⅳ:2 0ml·h -1 The lockout time of 5 mins,PCA bolus dose at 1 0ml and loading dose at 3 5 ml were set The pain scores of visual analog scale (VAS),sedative scores of Ramsay scale,demand bolus and delivery bolus of PCA,and respiratory and hemodynamic parameters were recorded at virous times postoperatively Result:The total dosage of narcotics did not differ among four groups As compared with those of group Ⅰ,the VAS and Ramsay scores decreased significantly,the ratio of delivery bolus to demand bolus increased markedly in group Ⅱ and Ⅲ (P<0 05),but without significant differences in them between group Ⅱ and Ⅲ In group Ⅳ the VAS score and the demand bolus of PCA were 0 During the whole period the respiratory and hemodynamic parameters changed unsignificantly in normal range The side effects did not occur Conclusion:It is more effective and safe for postoperative analgesia that the mixture,containing 10 μg fentanyl and 0 1 mg droperodol per ml,is administered by combination of CBI and PCA with the CBI rate at 1 0 1 5ml·h -1 ,the PCA bolus dose at 1 0 ml and lockout time of 5 min,and the loading dose at 3 0 5 0ml