大样本术后镇痛并发症与异常情况的回顾性分析

A large sample retrospective analysis of the complications and abnormal conditions in postoperative patient-controlled analgesia

目的通过对大样本术后镇痛并发症与异常情况的回顾性分析,指导临床工作中术后镇痛的管理。方法ASAⅠ～Ⅲ级手术患者2 792例,自控硬膜外镇痛（PCEA）1 015例,自控静脉镇痛（PCIA）1 777例。镇痛药物配方如下：（1）PCIA：芬太尼0.6～1.0 mg＋氟哌利多2～5 mg＋高乌甲素4～16 mg＋生理盐水至100ml;（2）PCEA：0.375%布比卡因15～40 ml＋芬太尼0.3～0.7 mg＋氟哌利多2～5 mg＋高乌甲素4～16 mg＋生理盐水至100 ml。术后每日2次进行VAS评分,监测镇痛效果,记录有关并发症与异常情况,及时对症处理。结果486例（17.4%）出现并发症与异常情况,常见为恶心呕吐（7.45%）,护士失误去掉镇痛泵（4.33%）,硬膜外导管脱出（2.04%）,镇痛效果差（1.43%）,肢体麻木（1.07%）。结论术后镇痛可以出现一些并发症与异常情况,制定术后镇痛管理制度,及时处理出现的并发症与异常情况,有利于患者康复。

Objective To retrospectively analyze the complications and abnormal conditions in a large sample of postoperative patient-controlled analgesia for directing the management of the post operative analgesia in clinic. Methods A total of 2 792 patients （ASAⅠ-Ⅲ）, 18 to 70 years old, was included in this study. 1 015 patients received the patient-controlled epidural analgesia （PCEA） and 1 777 received the patient-controlled intravenous analgesia （PCIA）. Analgesia drugs in PCIA were fentanyl （0.6-1.0 mg）, droperidol （2-5 mg） and lappaeonitine （4416 nag） in normal saline to 100 ml,while in PCEA were bupivacaine （0. 375%, 15-40 ml）, fentanyl （0. 3-0. 7 mg）, droperidol （2-5 mg） and lappaconitine （4416 mg） in normal saline to 100 ml. The effects of post- operative analgesia were monitored with VAS, twice everyday,and the complications and abnormal conditions were recorded. Results A total Of 486 patients （17.41%） had complications or abnormal conditions, the common was nausea and vomit （7.45 % ）,the analgesia pump removed by mistake by nurse（4.33%）, the epidural catheter prolapsed（2.04%）,poor effect of analgesia（1.43%） and the limbs numbness（ 1. 07%）. Conclusion There were many complications and abnormal conditions during postoperative analgesia. Establishing the management system of postoperative analgesia is essential, which can deal with the complications and abnormal conditions in time.