全子宫切除术后丁丙诺啡静脉与皮下镇痛疗效的比较

Comparison of the analgesic efficacy of Buprenorphine by PCIA and PCSA after hysterectomy

目的比较全子宫切除术后使用丁丙诺啡静脉自控镇痛(personal-controlled intravenous analgesia,PCIA)组和皮下自控镇痛(personal-controlled subcutaneous analgesia,PCSA)组术后镇痛的有效性、安全性和实用性。方法60例ASAⅠ-Ⅱ级全麻下行全子宫切除手术患者随机均分两组,PCIA组和PCSA组。患者术毕清醒述切口疼痛后,分别静脉、皮下给负荷剂量丁丙诺啡0.1 mg,接镇痛泵。镇痛泵药物配方相同:丁丙诺啡体质量0.015 mg/kg +0.9%生理盐水稀释到100 ml。观察记录术后各时间点的疼痛视觉模拟(visual analog scale,VAS)评分,Ramesay镇静评分,观察处理患者不良反应情况及PCA系统故障。结果两组患者Ramesay镇静评分无显著性差异,PCIA组2h时的VAS评分比PCSA组低(P<0.05),不良反应中恶心、嗜睡发生例数PCIA组比PCSA组多(P<0.05), PCIA组镇痛泵系统故障发生率明显高于PCSA组。结论两种给药方式均能达到术后镇痛的满意效果,PCSA操作简单,不良反应发生率低,并发症较少,更安全。

Objective To compare the analgesic efficacy, safety and practicality of Buprenorphine by patient-controlled subcutaneous analgesia （PCSA） and intravenous analgesia （PCIA） after hysterectomy. Methods Sixty patients who received hysterectomy under general anesthesia, ranked by ASA Ⅰ -Ⅱ, were randomized into two groups： PCIA and PCSA group. Loading dose （0.1 mg） of Buprenorphine was injected hypodermically or intravenously into patients by connecting with the analgesia pumps when they awaked from anesthesia and complained of pain. The inner ingredients of the pump were identical： Buprenorphine 0. 015 mg/kg diluted to 100 ml by normal saline. Visual analog scale （VAS） and Ramesay score were recorded at different time points. Side effects and PCA system dysfunctions were also observed. Results There was no difference in Ramesay score between two groups. VAS was lower in PCIA group than that in PCSA group after 2 hours of analgesia （ P 〈 0.05 ）. More main side effects of nausea, drowsiness were found in PCIA group（ P 〈 0.05 ）. The incidence of system dysfunction of the analgesia pump was higher in PCIA group. Conclusion Both PCSA and PCIA can be used in post-operation analgesia, but PCSA has a high efficacy with a lower incidence of side effects and may be more safe than PCIA.