皮下镇痛用于胆囊切除术后的临床研究

Clinical Research on the Application of Postcholecystectomy with Patient Controlled Subcutaneous Analgesia (PCSA)

目的：探讨皮下镇痛在胆囊切除术后镇痛应用的可行性。方法：选择ASAⅠ~Ⅱ择期行胆囊切除术患者180例,均采用连续硬膜外麻醉,随机分为S、E、I三组,每组60例。S组行皮下自控镇痛（PCSA）,E组行硬膜外腔自控镇痛（PCEA）,I组行静脉自控镇痛（PCIA）。术后采用VAS法记录术后2,6,12,24,48h的静息痛评分,48h内PCA按压次数和镇痛满意度评分。观测患者在术后的各个时间点的BP、HR、RR,SpO2的变化,并记录作者的不良反应的情况。结果：S、E、I三组均可为患者提供有效的术后镇痛,三组恶心呕吐、嗜睡、呼吸抑制等情况发生率无显著差异,但S组无尿潴留、肢体麻木感、静脉炎等并发症。结论：皮下自控镇痛（PCSA）可以克服静脉自控镇痛（PCIA）和硬膜外自控镇痛（PCEA）引起的尿潴留、肢体麻木感、静脉炎等并发症,且操作简单。

Objective：Study of subcutaneous analgesia after cholecystectomy in analgesia application.Method：Selection of elective cholecystectomy in 180 cases,all with continuous epidural anesthesia,were randomly divided into S,E,I three group,60 cases in each group.The group of S rows of subcutaneous patient-controlled analgesia（PCSA）,group E received epidural patient-controlled analgesia（PCEA）,I group received intravenous patient-controlled analgesia（PCIA）.After using the method of VAS recorded after 2,6,12,24,48h rest pain score,48h PCA press times and analgesic satisfaction scores.Observation of patients with postoperative all time points BP,HR,RR,SpO2 changes,and record the adverse situation author.Results：S,E,I three group can provide effective postoperative analgesia,three groups of nausea and vomiting,lethargy,respiratory depression,there was no significant difference between the S group,but no urinary retention,limb numbness,phlebitis and other complications.Conclusion：subcutaneous patient-controlled analgesia（PCSA） can overcome the patient-controlled intravenous analgesia（PCIA） and patient-controlled epidural analgesia（PCEA） induced urinary retention,limb numbness,phlebitis and other complications,and the operation is simple.