肘关节术后连续臂丛神经阻滞和静脉自控镇痛的比较

Elbow surgery continuous brachial plexus block and intravenous controlled analgesia comparison

目的将连续臂丛神经阻滞自控镇痛(PCNA)和静脉自控镇痛(PCIA)用于肘关节术后患者,比较两者的镇痛效能及不良反应发生情况。方法选择ASAⅠ～Ⅱ级,拟择期于全身麻醉下行肘关节手术的患者60例,随机分为PCNA组和PCIA组,术后分别给予连续臂丛神经阻滞自控镇痛和静脉自控镇痛。记录患者术后静息状态下2h、12h、24h和48h的疼痛评分以及镇静评分;术后24h和48h主动运动时的疼痛评分;其它镇痛药物使用情况、不良反应发生情况以及患者的满意度。结果 PCNA组术后2h、12h静息时VAS评分,以及术后24h、48h主动运动时VAS评分明显低于PCIA组(P<0.01或P<0.001)。PCNA组术后2h、12h镇静评分高于PCIA组(P<0.05或P<0.02),术后24h、48h镇静评分明显低于PCIA组(P<0.001);PCIA组患者术后恶心、呕吐发生率高于PCNA组,两组差异有统计学意义(P<0.01或P<0.05);PCNA组患者术后的满意度为93.33%,PCIA组为73.33%,两组差异有统计学意义(P<0.05)。结论与静脉自控镇痛相比,连续臂丛神经阻滞自控镇痛可以为肘关节手术患者提供更加完善的术后镇痛,同时其恶心、呕吐发生率也低于静脉自控镇痛,值得临床推广。

Objective To compare the analgesia and side effects of patient-controlled analgesia after continuous axillary brachial plexus block（PCNA） with patient-controlled intravenous analgesia（PCIA） for elbow surgery patients.Methods Sixty ASA class Ⅰ~Ⅱ patients undergoing elbow surgery were randomly divided into two groups with 30 cases each,and were given PCNA or PCIA respectively.Record the resting VAS score and Ramsay score 2h,12h,24h and 48h after surgery;the active moving VAS score 24h and 48h after surgery;the dose of additional analgesia drugs,the side effects and patient＇s satisfaction.Results Compared with PCIA group,the resting VAS score 2h,12h after surgery and active moving VAS score 24h,48h after surgery in PCNA group is lower（P〈0.01 or P〈0.001）.The Ramsay score in PCNA group is higher than PCIA group 2h and 12h after surgery（P〈0.05 or P〈0.02）,and lower than PCIA group 24h and 48h after surgery（P〈0.001）.The incidence of nausea and vomit in PCNA group is lower than PCIA group（P〈0.01 or P〈0.05）.The patient＇s satisfaction is 93.33% in PCNA group,and 73.33% in PCIA group（P〈0.05）.Discussion Conclusion with PCIA,continuous brachial plexus block can provide better postoperative analgesia for patients undergoing elbow surgery,and decrease the incidence of nausea and vomit.