硬膜外芬太尼和静注吗啡用于子宫切除术后病人自控镇痛

Patient controlled analgesia following cesarean section:A comparison with epidural fentanyl and i.v.morphine

目的 比较病人自控硬膜外芬太尼 (PCEAF)和病人自控静注吗啡 (PCIAM )在子宫切除术后的镇痛作用。方法 60例病人 ,进行随机、双盲研究。PCEAF组用芬太尼 2 0 μg ,锁定时间 10分钟 ;PCIAM组用吗啡 1mg ,锁定时间 7分钟。 结果 PCEAF组PCA应用少于PCIAM组 (P <0 0 1)。PCEAF病人疼痛最高分为 2 0 ( 10～ 3 3 ) ,而PCIAM组为 3 2 ( 14～ 5 2 ) (P <0 0 5 )。PCEAF组在咳嗽时最高评分为 3 1( 2 1～ 4 1) ,PCIAM组为 5 6( 3 0～ 71) (P <0 0 1)。PCEAF组恶心和嗜睡较少 ,瘙痒并发症发生率无差异。结论 硬膜外PCA给予芬太尼是安全的 ,并减少恶心的发生。

Objective To compare the effects of patient controlled epidural analgesia with fentanyl (PCEAF)with patient controlled analgesia with i.v.morphine (PCIAM) after cesarean section in 60 patients.Methods 60 patients were randomized into group PCEAF ( n= 30) and group PCIAM ( n= 30).Patients of group PCEAF received epidural fentanyl 20μg with a 10 min lockout.Patients of group PCIAM received i.v.morphine 1mg with a 5 min lockout.Results PCA dosage was lower in PCEAF group than that in PCIAM group( P< 0 001).The highest pain score recorded was 20(10 33)in PCEAF group and 32(14 52) in PCIAM group ( P< 0 01).The highest pain score recorded on coughing was 31(21 41) in PCEAF group and 56(30 71) in PCIAM group.There was less nausea( P< 0 05) and drowsiness in PCEAF group.There was no difference in the morbility and severity of pruritus betweenn the two groups.Conclusion PCA with epidural fentanyl was safe with aless nausea.