芬太尼静脉与皮下病人自控镇痛用于心脏手术后镇痛疗效的随机对照研究

RANDOMIZED CONTROLLED STUDY OF POSTOPERATIVE PAIN RELIEF EFFECT OF INTRAVENOUS PCA AND SUBCUTANEOUS PCA FENTANYL AFTER CARDIAC SURGERY

目的 :对经静脉与皮下芬太尼病人自控镇痛的疗效、安全性及实用性进行评价。方法 :将 64例ASAⅠ～Ⅱ级心脏手术后病人随机分为病人自控静脉镇痛 (PCIA)与病人自控皮下镇痛 (PCSA)组 ,其中PCIA组 31例 ,PCSA组 33例。药物为每毫升含芬太尼 2 5μg和利多卡因 1 0mg的混合液。PCA设置 :负荷量 2ml;单次剂量 1ml;背景剂量 0 .1ml/h ;小时限量 8ml/h ;锁定时间 3min。入选本研究的适应证是拔除气管导管后 8h内安静或咳嗽时疼痛视觉模拟评分在 3分以上 ,且无PCA禁忌证者。于负荷量注射完毕后记录镇痛起效时间 ,并于拔除气管导管后 2 4 ,48,72h记录各项指标。结果 :两组病人的一般情况及各项生命体征之间无显著性差异 (P >0 .0 5) ,两组间芬太尼用量、镇痛满意度及副作用无显著性差异。PCSA组镇痛起效时间显著长于PCIA组 (P <0 .0 1 ) ,PCSA组PCA报警次数百分率显著低于PCIA组 (P <0 .0 1 )。结论 :芬太尼PCIA与PCSA的疗效和副作用无显著性差异 ,但PCSA更方便简单 。

Objective: To compare the pain relief efficacy, safety and prognosis of intravenous PCA (PCIA) and subcutaneous PCA (PCSA). Methods: Sixty four patients (preoperative cardiac function of ASA I II ) were divided randomly into tow groups after cardiac surgery: Group PCIA (n=31) and Group PCSA (n=33). The mixture of fentanyl (25μg/ml) and lidocaine (10mg/ml) was given in both groups. PCA setting: Loading dose of 2ml, bolus dose of 1ml, background infusion of 0.1ml/h, hour limit of 8ml/h, and lockout time of 3 minutes was set. Patients with pain score above 3 on Visual Analog Scale 8h after extubation and without any contraindications of PCA were enrolled in this study. The following variables were recorded at time intervals of 24, 48, and 72 hours after extubation. Result: There was significant difference between Group PCIA and Group PCSA in onset of analgesia ( P < 0.01). Equipment breakdown in Group PCSA was markedly lower than that in Group PCIA ( P <0.01). There were no differences in sexual distribution, state of drink, level of education, analgesia efficacy, incidence of nausea and vomiting, patient satisfaction, recovering time of gut motility, and postoperative hospitalization ( P >0.05). Conclusion: It is suggested that PCSA is better than PCIA, which might be a much more safe and practical method for postoperative pain control.