皮下与静脉注射吗啡病人自控镇痛的临床研究

Patient Controlled Analgesia: A Comparison of Intravenous versus Subcutaneous Morphine

目的：比较皮下注射吗啡ＰＣＡ（ＰＣＳＡ）与静脉注射吗啡ＰＣＡ（ＰＣＩＡ）在术后镇痛中的疗效及安全性。方法：３０例在硬膜外麻醉下行妇科手术患者，随机分为ＰＣＩＡ组与ＰＣＳＡ组，每组１５例。ＰＣＩＡ组与ＰＣＳＡ组单次给药剂量每次分别为１ｍｇ、２５ｍｇ，锁定时间分别为５ｍｉｎ、２０ｍｉｎ。在术后感觉疼痛时，由患者自己给药镇痛。术后４、８、１２、２４ｈ随访并记录吗啡用药量、用药次数、疼痛评分（ＶＡＰＳ）、平均动脉压和呼吸频率及恶心呕吐等副作用情况。结果：术后２４ｈ应用吗啡总量ＰＣＳＡ组为３０４±１００ｍｇ，明显高于ＰＣＩＡ组的１８０±６０ｍｇ（Ｐ＜００１）。术后０～８ｈ，ＰＣＩＡ组镇痛效果优于ＰＣＳＡ组；两种镇痛方法的总体满意度、恶心、呕吐发生率无显著性差异。结论：ＰＣＩＡ的术后镇痛效果优于ＰＣＳＡ。

Objective: To compare the efficacy and safty of patient controlled analgesia by either intravenous or subcutaneous morphine. Methods: Thirty patients undergoing gynecological procedures under epidural anesthesia were randomly allocated to patient controlled intravenous morphine (PCIA) group or patient controlled subcutaneous morphine (PCSA) group. The demand dose and the lockout time were 1mg and 5min in the PCIA group, and 2 5mg and 20min in the PCSA group respectively. At 4,8,12, and 24h following operation, the severity of pain, incidence of nausea and vomiting, RR, MAP and overall satisfaction of pain relief were assessed. Results: The total dosage of morphine administered was significantly higher in PCSA group (31 0±10 0mg) than that in PCIA group (18 0±6 0, P< 0 01). The postoperative pain scores from 0 to 8h in the PCIA group were lower than those in the PCSA group. There was no significant difference between the two groups in the incidence of nausea and vomiting and the overall satisfaction of pain relief. Conclusion: PCIA is better than PCSA in postoperative pain relief.