芬太尼皮下镇痛用于妇科手术后的临床观察

A Clinical Observation of Fentanyl PCSA for Postoperative Analgesia in Patients underwent Gynecologic Surgery

目的观察妇科手术后芬太尼皮下自控镇痛（PCSA）与静脉自控镇痛（PCU）的效果及不良反应。方法60例ASAⅠ-Ⅱ级妇科开腹术后的患者随机分为PCSA组和PCIA组。PCSA组镇痛液的配方为芬太尼25μg／kg＋2％利多卡因10mL＋生理盐水至100mL；PCIA组镇痛液配方为芬太尼18μg／kg＋2％利多卡因10mL＋生理盐水至100mL。PCA泵持续输注速度为2mL／h，PCA为0．5mL／次，锁定时间为15min。分别观察患者术后4、8、12、24h和48h各时间段的视觉模拟评分（VAS）、Ramsay镇静评分（RSS）、PCA按压次数、病人满意度及不良反应的发生情况。结果除术后4、8hPCSA组VAS评分高于PCIA组（P〈0．05）外，其它各时间段VAS评分、RSS评分和PCA按压次数两组间差异均无统计学意义（P〉0．05），术后4、8h PCA泵按压次数高于其它时间段（P〈0．05）。PCSA与PC认满意率分别为90％和95％；PCSA组恶心呕吐等不良反应低于PCIA组（P〈0．05）。结论妇科患者术后芬太尼皮下镇痛是一种方便可靠的术后镇痛技术，不良反应少，值得临床推广应用。

Objective To observe and compare the efficacy and side effects of fentanyl patient-controlled subcutaneous （PCSA） and intravenous analgesia（PCIA） in patients underwent Gynecologic surgery. Methods Sixty patients （ASA Ⅰ to Ⅱ ） were randomly divided into two groups with 30 cases each. PCSA group were given analgesic mixture of fentanyl 25μg/kg and 2%lidocaine 10mL in normal saline 100 mL, while PCIA group was given analgesic mixture fentanyl 18μg/kg and 2%lidocaine 10ml in normal saline 100 mL. PCA was set as continuous dose of 2. 0mL/h,bolus dose of 0.5mL and lock-out time of 15mins in 48 h. The visual analogue scale （VAS） and Ramsay sedation score （RSS） were assessed at 4h,8h, 12h,24h and 48h after operation. Pressed times of PCA pump, the satisfactory percent of analgesic effect from patients and side effects were also recorded. Results VAS, RSS and pressed times were not siguificantly different between two groups during PCA（ P 〉 0.05） except VAS in group PCSA were higher than those in group PCIA 4h,8h after operation（ P 〈 0.05）. The satisfactory rate in group PCSA and PCIA were 90% and 95% respectively,however phlebitis and inability of limbs could be avoided in group PCSA. Side effects such as nausea and vomiting were significantly more in group PCIA than those in group PCSA （ P 〈 0.05）. Conclusion Fentanyl PCSA for postoperative analgesia in patients underwent Gynecologic surgery is a convenient and effective technique with fewer side effects. It is deserved to be used extensively in clinical work.