硬膜外术后镇痛最佳注药模式的探讨

The Reserch of the Best Mode of Postoperative Epidural Analgesia

目的 :比较硬膜外术后镇痛不同注药模式与量效的关系 ,探讨最佳注药模式。方法 6 0例 32～ 76岁ASAⅠ～Ⅱ级行直肠癌根治术的病人随机分为三组作术后硬膜外镇痛。药物配方相同 ,负荷剂量相等。Ⅰ组选病人自控 ,单纯PCEA模式 ,Ⅱ组选持续恒量注药 (CCEA)模式 ,Ⅲ组选短时间连续恒量注药加病人自控注药 (CC +PCEA)模式。对病人行 2 4小时血压、心率及SPO2 连续监测并观察镇痛效果、不良反应及 2 4小时用药量。结果 :(1 )观察期间三组血压、心率及呼吸均在正常范围 ,术后恶心呕吐发生率无显著性差异 ;(2 ) 2 4小时用药量分别为 33.2 5± 8.2 6ml、48ml和36 .30± 6 .2 4ml,Ⅰ组和Ⅲ组均小于Ⅱ组 (P <0 .0 1 )。 (3)术后 2～ 8小时镇痛效果Ⅰ组、Ⅲ组均优于Ⅱ组 (P <0 .0 5 )。讨论 :硬膜外术后镇痛以短时间CC +PCA注药模式效果最佳。连续恒量输注时间以 1 2小时为宜。

Objective: To compare the effects, drug dosage and untoward reactions of three modes of postoperative epidural analgesia ,so as to choose the better one. Methods: 60 postoperative rectum cancer patients were randomly divided into three groups (n=20). The ingredient of the drug in three groups are same.( 0.005% morphine,0.25% bupivacaine, 0.000 15% scopolamine, and 0.0025% droperidoli mixture). Group Ⅰ were infused with the patient control analgesia mode (PCA), Group Ⅱused with continuous, constant mode (CC),Group Ⅲ used short time continuous(postoperative 6～12hour), constant mode, together with PCA(CC+PCA).The patient's BP, HR and SpO 2 were monitored constantly and the 24 hour injection dosage was recorded. The analgesie effects and untoward reactions were observed. Results: (1)The 24 hour drug dosage in Group Ⅰ, Ⅱ and Ⅲ was 33.25ml±8.26ml, 48ml and 36.30±6.24ml. The Group II was obviously higher than Group Ⅰ and Ⅲ ( P <0.05). (2)The Group Ⅰ and Ⅲ were superior to Group Ⅱ in analgesie effect during postoperative 2～8 hour. (3)During the period of observation, the BP, HR, and RR were all within normal range. There was no significant difference among the three groups in vomiting occurrences. Discussion: Patients' pain threshold and psychological needs for postoperative analgesia are greatly variant. CCEA mode could not be adjusted according to individual need. To some patients, the dosage may be unnecessarily high, but for some others, it may not be enough to relieve the pain. PCEA mode takes full consideration of individual differences and is in conformity with the analgesia principles. CC+PCEA mode is superior to other modes in postoperative epidural analgesia.It not only can meet the needs of individuals,but also let the patients have a good rest without handling the button frequently during postoperative forepart. And there is no need for continuous and constant infusion for 24 hours long.