自控硬膜外镇痛用于腹部手术后病人的护理评价

Nursing evaluation on patients with patient control epidural analgesia after abdominal surgery

目的对采用自控硬膜外镇痛病人的镇痛镇静效果及心理学变化等进行评价。方法随机选择施行腹部手术的病人为镇痛组（n=70），采用光达电子泵向硬膜外控连续输注镇痛复合液（0．5％的布比卡因20ml，芬太尼0．4mg，昂丹司琼8mg加生理盐水至100ml）；对未行PCEA的病例列为对照组（n=70），分别于术后2、6、10、16、24h进行疼痛视觉模拟计分（VAS），Ramsay镇静评分；并于术前、术后24h进行心理学调查（SAS、SDS）和对BP、HR变化、生活质量进行评估。结果发现镇痛组VAS〈1，Ramsay镇静评分在2．1—3．2之间，SAS、SDS也分别由术前42．5±3．1，42．8±2．2降至术后的40．6±3．2，39．8±3．2（P〈0．05），BP、HR相对平稳；生活质量、依从性也相对提高；而对照组的VAS评分〉4．70，Ramsay镇静评分界于0．89—1．22之间，SAS、SDS由术前的42．5±2．8，42．64-2．2分别增加到44．5±2．7，43．7±2．6（P〈0．05）；BP升高不明显，HR明显增快，术后自理能力，对医护人员的依从性也相对较差。结论PCEA术后镇痛、镇静可靠，有利于心理状态、血液动力学稳定和术后康复。

Objective To evaluate the effects of patient control epidural analgesia （PCEA） on analge- sia, sedation. Psychology, HR, BP and life quality in patients after abdominal surgery. Methods Patients were consecutively randomized in to analgesia group （ n = 70） in which PCEA were used, analgesic solution （0. 5% bubivacalne 20 ml, fentany 10.4 rag, ondansetron 8 mg diluted to 100 nd with 0. 9% NaC1） were continuously infusion in to epidural Cavity with electronic pump; Those patients without PCEA were control group （n = 70）, VAS, Ramsay sedation scal and changes of BP, HR were monitor in 2, 6, 10, 16, 24 h post operation and SAS. SDS were investigate before operation and 2d after surgery respectively. Simultaneously. The life quality and dependence with nurse were observation by nurses. Results All patients in analgesic group presented the best analgesic sedation efficacy, VAS scores 〈 1, Ramsay sedation scale in between 2. 1～ 3.2, SAD （40. 6）, SDS （39. 8 ） post operation were significantly less than SAD （42.5）, SDS （ 42. 8 ） before operation （ P 〈 0.05 ）, BP, HR were relative stability at various time points, life quality have been obviously improved; In the control group, VAS scores. Ramsay scale were 〉 4. 70, Ramsay sedation scale in between 0. 89 ～ 1.22, the SAS （44. 5）, SDS （43. 8） of post operation were oberviously increase （P 〈0. 05） than before operation, HR were increased in various time point expertly 2 h post operation and there were severe anxious reaction have been observation, wheares patient life quality dependence were reduction than analgesic group. There were significantly difference （ P 〈 0.05） for VAS Ramsay sedation seal and SAS. SDS between two groups compared in various time points after surgery （ except 2 h post operation） . Conclusion PCEA may be provided effective postoperative analgesia, reduce psychological reaction, and improve life quality, in which beneficial for patient recovery.