静脉与硬膜外自控镇痛对下肢手术患者胃肠道功能的影响

Effects of PCIA and PCEA on Gastrointestinal Function Restoration in Patients Underwent Lower Limb Surgery

目的比较目前常用的两种镇痛方式即患者静脉自控镇痛与硬膜外自控镇痛对下肢手术患者胃肠道功能的影响。方法随机选择在全麻下择期行下肢骨科手术的患者80例,ASAⅠ～Ⅱ级,年龄18～45岁,体重于标准体重±10%范围内,分为4组,每组20例。I组为术后患者静脉自控镇痛(PCIA),分两亚组即:I1组(盐酸曲马多+枸橼酸芬太尼),I2组(盐酸曲马多+枸橼酸芬太尼+盐酸格拉司琼)。E组为术后硬膜外自控镇痛(PCEA)。C组为空白对照组术后按需肌注盐酸哌替啶1 mg/kg。术后镇痛期间观察记录患者一般情况,胃肠道功能恢复情况(首次排气时间、恶心呕吐发生率、肠蠕动恢复时间)等项目。结果 4组患者术后胃肠道功能的比较:E组首次排气时间较其他组显著提前(P<0.05)。I2组首次排气时间较I1组和C组延后,差异有统计学意义(P<0.05)。I1组和C组首次排气时间差异无统计学意义(P>0.05)。E组胃肠道蠕动恢复时间较其他组显著提前(P<0.05)。其余3组间差异无统计学意义。I1组术后第12、天的恶心呕吐率高于其他3组(P<0.05)。其余各组差异无统计学意义(P>0.05)。第3天各组患者均无恶心呕吐发生。结论对于下肢骨科手术后患者,硬膜外镇痛能显著的增强下肢术后患者胃肠道功能恢复,格拉司琼能明显减轻术后恶心,呕吐的发生,但延长肛门首次排气时间。

Objective To compare the effect of two commonly used methods for analgesia,PCIA and PCEA,on the gastrointestinal function of patients who received lower limb surgery.Methods Eighty patients who received elective lower limb surgery under general anesthesia were randomly selected,ASA Ⅰ-Ⅱ grade,18 to 45 years old,body weight were within standard body weight ± 10%.The 80 cases were divided into 4 groups,20 cases for each.Patients in group I received patient-controlled intravenous analgesia（PCIA） after surgery,divided into two sub-groups.group I1（tramadol hydrochloride＋fentanyl citrate） and group I2（tramadol hydrochloride＋fentanyl citrate＋granisetron hydrochloride）.Patients in group E received epidural analgesia（PCEA） after surgery.Patients in group C as control received intramuscular injection of pethidine hydrochloride 1 mg/kg as demand after surgery.The general situation,the recovery of gastrointestinal function（first exhaust time,the incidence of nausea and vomiting,bowel movement recovery time） and other projects were observed and recorded during the period of postoperative analgesia.Results In the comparison of postoperative gastrointestinal function of four groups,the first exhaust time of group E was significantly earlier than that of other groups（P0.05）.The first exhaust time of group I2 was longer than of group I1 or group C,with the difference statistically significant（P0.05）.The first exhaust time between group I1 and group C was not significantly different（P 0.05）.The gastrointestinal motility recovery time of group E was significantly earlier than the others（P0.05）.There was no significant difference between the remaining three groups（P0.05）.The nausea and vomiting rate of group I1 in the first and second days after surgery was significantly higher than the other groups（P0.05）,there was no significant difference between the remaining three groups（P0.05）.No nausea and vomiting occurred on the third day after surgery in patients of each group.Conclusion Epidural analgesia can significantly enhance gastrointestinal functional recovery of patients after lower limb surgery.Granisetron can significantly reduce the occurrence of postoperative nausea and vomiting（PONV）,but extend the onset time of postoperative exhaust