患者自控镇痛泵的术后镇痛时间与效果分析

Time-effectiveness analysis of patient-controlled analgesia in post-operative pain

目的本研究对湖南省级医院术后患者自控镇痛泵(PCA)的使用情况和镇痛效果进行调查分析,为医务人员更合理地选用PCA提供参考。方法随机选取42例开放式手术患者,按其术后疼痛处理方法的不同分为3组:1组为对照组(无处理组),21例;2组为PCA 24 h组,使用PCA 24 h,8例;3组为PCA 48 h组,使用PCA 48 h,13例。由非麻醉科人员采用11点数量评分法(NRS-11)评估患者疼痛。对所得术后0,1,2,4,6,8,12,24,36,48,72 h各时点的疼痛评分进行重复测量数据的方差分析,评估PCA的术后镇痛效果。结果①在术后第1日,3组间疼痛强度的差异具有统计学意义(P<0.05)。经两两比较,PCA 24 h和PCA 48 h组在术后第1日的疼痛强度均显著低于无处理组(P<0.05);PCA 24 h和PCA 48 h组在术后第1日疼痛强度的差异无统计学意义(P>0.05)。②在术后第2日和第3日,3个不同处理组间的疼痛强度的差异均无统计学意义(P>0.05)。③随着患者伤口愈合,病情好转,各组间的疼痛评分趋于一致,在术后72 h降至2左右。结论①PCA在术后第1日能够有效地控制患者的疼痛;②对于开放式手术术后疼痛的控制,使用PCA 24 h较使用PCA 48 h更为合适。

Objective To evaluate the applied condition and analgesic effectiveness of patientcontrolled analgesia （PCA） in post-operative pain in Hunan provincial grade hospital, and to provide refer- ences for medical staff adopting PCA. Methods Forty-two patients undergoing open operation were selectd randomly, and divided into 3 groups according to the different types of post-operative pain management. Group 1 was the control group which was given no pain management, Group 2 was the PCA 24 h group used PCA for 24 h, Group 3 was the PCA 48 h group used PCA for 48 h. Numerical rating scale 11 （ NRS- 11 ） was used to assess the intensity of patients＇ pain and repeated measures analysis of variance method was used to analyze the post-operative pain score at 0,1,2,4,6,8,12,24,36,48,72 hours by non-anesthesiologists. Results There was a significant difference in pain intensity among the three groups during the first day （ P 〈0.05）. By comparison of each two, there was a significant reduction in pain intensity of Group 2 and Group 3 than that in Group 1 （P 〈0.05）, but there was no significant difference in pain intensity between Group 2 and Group 3 （ P 〉0.05 ）. There was no significant difference in pain intensity among the three groups during the second and third day （ P 〉0.05 ）. And the postoperative pain scores of each group dropped to about 2 at 72 h equally. Conclusion PCA is effective for post-operative pain control in the first day. However,it is more suitable to use PCA for 24 h than for 48 h to control post-operative pain.