骨科术后病人不同自控镇痛方法的应用评价

EVALUATION OF PATIENT CONTROLLED ANALGESIA FOR POSTOPERATIVE ORTHOPEDIC PATIENTS

为评价不同自控镇痛法 ( Patient controlled analgesia PCA)在骨科手术后的镇痛效能 ,将 90例骨科术后病人随机均分为3组 :A组采用硬膜外 PCA,药用布比卡因 -吗啡 ;B组也采用硬膜外 PCA,药用布比卡因 -芬太尼 ;C组采用静脉 PCA,药用吗啡。结果显示 ,全部病人术后恢复良好 ,无严重的并发症出现 ;三组病人镇痛效果相同 ( P>0 .0 5 ) ,但 C组病人术后 8～ 2 4h内镇静作用明显 ( P<0 .0 1)。 A组吗啡用量为 12 .5± 4.6 ( mg) ,B组芬太尼用量 5 35 .6± 2 0 5 .7(μg) ,C组吗啡用量 41.5± 15 .5 ( mg) ,A组、C组药物用量与 B组比较 ,有显著差异 ( P<0 .0 1)。A组病人术后尿潴留和低血压明显 ( P<0 .0 1) ;而 C组病人术后瞌睡、头昏明显 ( P<0 .0 5 ) ;肠功能恢复顺序为 B组 <A组 <C组 ,组间有明显差异 ( P<0 .0 5 )。表明三种 PCA法均可以用于术后镇痛 ,经综合比较 ,自控硬膜外布比卡因 -芬太尼 ( B组 )

In order to evaluate the analgesic effect of patient controlled analgesia(PCA)after orthopedic operation,90 cases of orthopedic patients were divided into 3 groups at random:Group A of with morphine,Group B of extradural PCA with bupivacaine fentanyl and group C of venous PCA with morphine.The results showed that all the patients recovered well after operation without severe complications.the 3 groups presented similar analgesic effect( P <0.05).In group A,the dosage of morphine was 12.5±4.6mg,in Group B fentanyl 535.6±205.7ug and in Group C morphine 41.5±15.5mg which,compared with Group A,had significant difference( P <0.01).Patients in Group A had remarkable uroschesis and hypotension( P <0.01)while patient in Group C had sleepiness and dizziness( P <0.05).The functional recovery order of intestines was Group B<Group A<Group C with significant difference between groups( P <0.05).Through comprehensive comparsion,extradural PCA with bupivacaine-fentanyl is the best choice for postoperative analgesia in orthopedics.