静脉和硬膜外自控镇痛法用于剖宫产术后镇痛的临床观察

Clinical assessment of the effect of intravenous patient controlled intravenous analgesia and epidural patient controlled epidural analgesia in postoperative analgesia

目的 观察患者静脉自控镇痛 (PCIA)和硬膜外自控镇痛 (PCEA)法用于剖宫产术后镇痛的效果。方法 选取剖宫产术后患者 2 40例 ,随机分成PCIA组、PCEA组和对照组 ,每组 80例。PCIA组和PCEA组患者应用含吗啡 2 0mg、氟哌定醇 5mg的自控镇痛 (PCA)泵 ,根据术后疼痛程度患者自控给药。对照组患者则不用任何药物。采用视觉模拟评分法 ,分别观察 3组患者术后的镇痛效果、肠蠕动恢复时间、拔尿管后排尿情况、产后出血、子宫复旧及泌乳情况和是否有恶心呕吐、皮肤搔痒及呼吸抑制情况。结果 (1)PCIA组与PCEA组患者术后无明显疼痛感 ,镇痛效果良好 ,两组比较 ,差异均无显著性 (P >0 0 5 ) ;而对照组患者则有明显的术后疼痛感。 (2 )PCEA组患者的术后肠蠕动恢复时间为 (17 5 1± 10 33)h ,明显快于PCIA组患者的 (2 8 70± 16 36 )h ,两组比较 ,差异有极显著性 (P<0 0 1)。 (3)PCIA组 10例患者发生拔尿管后排尿困难 ,PCEA组为 2 7例 ,两组比较 ,差异有显著性 (P<0 0 5 ) ;对照组仅有 3例 ,明显少于PCIA组和PCEA组。 (4 ) 3组患者恶心呕吐、皮肤搔痒、呼吸抑制发生情况比较 ,差异均无显著性 (P >0 0 5 )。 3组患者产后出血、子宫复旧及泌乳情况比较 ,差异均无显著性 (P >0 0 5 )。结论 PCIA及PCEA均有良好?

Objective To compare the clinical effect and side effect of intravenous patient controlled intravenous analgesia (PCIA) with patient controlled epidural analgesia (PCEA). Methods Two hundred and fourty postoperative patients,who were randomly divided into three groups:group PCIA,group PCEA and control, 80 cases for each group,and the recovery of bowel movement,urinary retention,nausea,vomiting,pruritis,respiratory depression,postpartum hemorrhage,lactation and recovery of uterus were observed after operation. Results Overall patients in two PCA groups were satisfied with the postoperative analgesia. The incidence of urinary retention in group PCIA were significantly lower than that in group PCEA( P <0 05). The recovery of bowel movement in group PCEA (17 51±10 33) was much beffer than that in group PCIA (28 70±16 36) ( P <0 05). There were no remarkable differences between two PCA groups in nausea, vomiting, respiratory depression and pruritis ( P >0 05). There were no remarkable differences between two PCA groups and control in the incidence of postartum hemorrhage, lactation and recovery of uterus. Conclusions Both PCIA and PCEA have excellent analgesic effect. PCIA has lower incidence of urinary retention,and has higher sedative incidence compared with PCEA.