肿瘤患者术后静脉自控镇痛的临床应用

Clinical Application of Patient-Controlled Infusion Analgesia in Cancer Patients

目的:总结肿瘤患者术后静脉自控镇痛(patient-controlledinfusionanalgesiaPCIA)的效果。方法:600例ASA(美国麻醉医师协会分级法)Ⅰ～Ⅱ级术后患者,随机分为3组,每组200例。Ⅰ组为吗啡PCIA组,Ⅱ组为芬太尼持续背景静脉输注(continousbackgroundinfusionofnarcoticsCBI)组,Ⅲ组为芬太尼持续背景静脉输注的基础上,患者可自控输注小剂量芬太尼(5μg)组。观察3组患者术后4小时、8小时、12小时、24小时、48小时和72小时呼吸、循环、镇痛、镇静评分及不良反应。结果:3组镇痛方法的总满意度优良率均为90%以上,相比无显著性差异(P>0.05),但从镇痛、镇静效果比较,第Ⅲ组略优于Ⅰ、Ⅱ两组,而Ⅰ组患者呼吸抑制发生率低,安全性高,使用时间长。结论:术后静脉自控镇痛适用于手术创伤大、对疼痛耐受性差的患者。

Objective:To evaluate the analgesic effect of postoperative patient-controlled infusion analgesia(PCIA)in cancer patients.Methods:Six hundred postoperative ASAI-Ⅱpatients were randomly devided into3groups(n=200):GroupⅠwas PCIA group(infusing morphine);GroupⅡCBI group(continuous background infusion);GroupⅢCBII+PCIA group(continuous in fusing fentanyl mixed with PCIA).The respiratory and circulatory functions,analgesic score,se dation score and side-effect were monitored at4hrs,8hrs,12hrs,24hrs and72hrs after operation respectively.Results:There were no differences of analgesic effect in3groups(P>0.05).The satisfactory degree were beyond90%.The sedation effect in groupⅢwas better than those in groupⅠand groupⅡ,but the incidence of respiratory function depress was lower and analgesic duration was longer in groupⅠ.Conclusion:PCIA is suitable for those patients with poor pain tolerance and serious trauma.