硬膜外与静脉泵注芬太尼病人自控镇痛的比较

Comparison of Patient-controlled Analgesia of Epidural with Intravenous Fentanyl

目的 比较术后经硬膜外和静脉应用芬太尼病人自控镇痛 (PCA)的临床效果和安全性。方法 6 0例上腹部和胸部手术病人随机分为经硬膜外注射芬太尼病人自控镇痛 (PCEA)组和静脉注射芬太尼病人自控镇痛 (PCIA)组 ,每组 30例。 2组芬太尼负荷量为 0 0 0 1mg/kg ,PCA药物配方均为芬太尼 0 5mg +氟哌利多10mg + 0 9%氯化钠至 10 0ml ,持续给药注速 2ml/h ,单次PCA剂量 0 5ml ,锁定时间 15min。术后定时进行镇痛、镇静评分 ,2 4h芬太尼用量 ,患者满意度及不良反应的观察比较。结果 PCEA组 2 4h用药量、按键次数及术后视觉模似评分 (VAS)均明显高于PCIA组 (P <0 0 5 )。 2组镇静评分低且无明显差异。患者对术后镇痛总体满意程度良好至优秀均在 83 3%以上 ,不良反应发生率 2组间无显著性差异。结论 芬太尼用于术后镇痛安全有效。但芬太尼PCIA镇痛效果明显优于芬太尼PCEA ,且用药量少。

Objective To compare the efficacy and safety of patient-controlled analgesia (PCA) of epidural with intravenous fentanyl. Methods 60 patients undergoing ordinary epigastrial or thoracic operation were randomly allocated to patient-controlled epidural analgesia (PCEA) group (n=30) or patient-controlled intravenous analgesia (PCIA) group (n=30). The PCA solution consisted of fentanyl 0.5mg, droperidol 10mg and NS 86 ml, loading dose of fentanyl was 0.001mg/kg, and background infusion 2ml/h, bolus 0.5ml, lockout time 15min. the severity of pain, incidence of nausea and vomiting, total dosage of fentanyl used in 24h and patient's satisfaction were assessed. Results The total dosage of fentanyl administered, the times of temporarily pressing the PCA key and the postoperative pain scores were significantly lower in the PCIA group than in the PCEA group. Between two groups, there was no significant difference in the overall satisfaction of pain relief, sedation and vomiting. Conclusion PCIA with fentanyl might be better than PCEA with it for postoperative pain relief.