不同自控镇痛模式用于腹腔镜下子宫肌瘤剔除术的临床效果观察

Clinical Observation of Different Patient-controlled Analgesia Modes in Laparoscopic Hysteromyomectomy

目的观察不同自控静脉镇痛模式用于腹腔镜下子宫肌瘤剔除术的临床效果。方法选择择期全麻下行腹腔镜子宫肌瘤剔除术患者60例,ASA分级Ⅰ~Ⅱ级,随机分为3组(0组、1组、2组),每组各20例。所有患者均在切皮前15 min静滴帕瑞昔布钠40 mg进行预防性镇痛,手术结束前30 min静脉注射舒芬太尼0.1μg/kg作为负荷剂量,术毕拔管后连接自控静脉镇痛(PCA)泵(内含舒芬太尼2μg/kg,以生理盐水配至100 m L)。观察术后T1(2 h)、T2(4 h)、T3(12 h)、T4(24 h)、T5(48 h)泵内舒芬太尼的总用药量、PCA按压总次数、疼痛视觉模拟评分及镇静评分、不良反应发生率、患者舒适度评分及术后首次排气时间。结果0组舒芬太尼用药量最少,且疼痛评分与1组、2组比较无统计学差异(P>0.05),术后首次排气时间短于2组(P<0.05)。3组不良发应发生率无统计学差异(P>0.05)。结论根据3组不同镇痛模式的临床观察,在帕瑞昔布钠作为预防性镇痛的基础上,单纯PCA镇痛模式更适用于腹腔镜下子宫肌瘤剔除术患者的术后镇痛。

Objective To investigate the chnical effect of different patient-controlled analgesia （PCA） modes in patients undergoing laparoscopic hysteromyomectomy. Methods Sixty patients scheduled for a laparoscopic hysteromyomectomy were randomly divided into three groups. All pa- tients received an intravenous infusion of pareeoxib sodium （40 nag） as preventive analgesia 15 rain prior to the skin incision. Thirty minutes prior to the end of surgery, they received an intravenous injection of sufentanil （0.1μg/kg） as a loading dose. The following data were collected： the total dosage of sufentanil, the total and valid frequency of the PCA press, visual analog pain score, sedation score, the incidence of adverse reactions, the incidence of adverse reactions per group. Results Compared to groups 1 and 2, group 0 had the lowest dosage of sufentanil. There was no significant difference in the incidence of adverse reactions between the three groups （P 〉0.05）. Conclusion The PCA-only mode, in conjunction with pareeoxib sodium as preventive analgesia, was more suitable for patients undergoing laparoscopic hysteromyomeetomy.