胸腹部术后患者不同镇痛方式的镇痛效果比较

Comparative Study of Different Analgesic Methods after Thoracic and Abdominal Surgery

目的通过对胸腹部术后患者不同镇痛方式镇痛效果的比较,探讨一种安全、有效、经济的镇痛方式。方法将180例胸腹部手术患者随机分成三组,每组各60例,术后分别采用不同的镇痛方式:A组肌内注射哌替啶,B组患者自控硬膜外镇痛,C组采用微量泵缓慢静脉泵入镇痛剂。分别于术后1、6、24、48h记录患者的疼痛评分、脉搏血氧饱和度(SpO2)、心率(HR)及呼吸频率(RR)。结果手术前后比较,A、B组患者术后各时点的HR、RR均增快,SpO2有不同程度的下降;C组患者术后1、6h的HR及1h的RR有所增快(P<0.05)。组间比较,B、C组患者术后各时点视觉模拟评分法(visual analoguescale,VAS)评分明显低于A组(P<0.05);C组术后1、6、48h的VAS评分低于B组,术后各时点的HR、RR均低于A、B组(P<0.05),术后1、6、24h的SpO2高于A、B组(P<0.05)。结论患者自控硬膜外镇痛及微量泵缓慢静脉泵入镇痛剂均能起到较好的镇痛作用,而且后者的镇痛效果更好,对患者呼吸、循环功能的影响较小。

Objective To compare the different analgesic methods after thoracic and abdominal surgery so as to explore a safe,effective and economic method of analgesia.Methods A total of 180 patients with thoracic and abdominal surgeries were equally randomized into group A with intramuscular injection of pethidine,group B with patient-controlled epidural analgesia（PCEA）and group C with slow intravenous analgesics infusion via micro pump.The patient＇s pain scores,adverse events,pulses,oxygen saturation（SpO2）,heart rates（HR）,respiratory rates（RR）at 1,6,24,48 h after operation were recorded accordingly.Results Compared with the pre-anesthesia,the levels of HR and RR were elevated and the SpO2 level was decreased in varying degrees at each postoperative time point on the patients of group A and group B.The HR level at 1,6 h and RR level at 1 h after operation were elevated on the patients of group C（P0.05）.The postoperative VAS scores at each time point of group B and group C were significantly lower than those of group A（P0.05）.The postoperative VAS scores at 1、6、38 h and the postoperative levels of HR and RR at each time point were lower in group C than those in group B and those in group A and group B respectively（P0.05）.The postoperative SpO2 levels at 1,6,24 h were higher in group C than those in group B and group C（P0.05）.Conclusion Both PCEA and slow intravenous analgesics infusion via micro pump can produce satisfactory analgesic effects.The analgesic effect of the latter is comparatively more effective with less influence in respiratory and circulatory functions of patients.