皮下PCA与静脉PCA用于心脏外科术后镇痛疗效的比较

THE PAIN-RELIEVING EFFECT OF INTRAVENOUS PCA AND SUBCUTANEOUS PCA WITH MORPHINE AFTER CARDIAC SURGERY

目的 :评价经静脉和皮下吗啡PCA的疗效、安全性及实用性。方法 :将 6 3例ASAI～III级心外科术后病人随机分为吗啡病人自控皮下镇痛 (scPCA)与病人自控静脉镇痛 (ivPCA )组 ,其中scPCA组 31例 ,ivPCA组 32例。药物为吗啡 1mg/ml+利多卡因 10mg/ml的混合液。PCA设置 :负荷量 2ml;单次剂量 1ml;小时限量 10ml/h ;锁定时间 3分钟。于负荷量注射完毕后记录镇痛起效时间 ,并于放置PCA泵后 2 4、4 8、72小时记录疼痛VAS评分、镇静程度、MAP、HR、RR、SPO2 、PCA需求按压和有效按压次数及副作用。结果 :ivPCA组镇痛起效时间显著短于scPCA组 (P <0 .0 5 ) ;两组疼痛评分及副作用发生率无显著性差异。scPCA组PCA泵报警次数显著低于ivPCA组 (P <0 .0 5 )。结论 :吗啡scPCA与ivPCA的疗效和副作用无显著性差异 ,但吗啡scPCA操作简单、系统故障发生率低 ,适于较长时间留置。

Object: To evaluate the effect, safety and availability of Intravenous PCA (ivPCA) and Subcutaneous PCA (scPCA) with morphine. Method: Sixty three patients undergoing cardiac surgery (ASA I to III) were assigned randomly into two groups: Group scPCA (n=31) and group ivPCA (n=32).The mixture of morphine 1mg/ml and lidocaine 10mg/ml was administered in both groups. PCA setting: Loading dose of 2ml, bolus dose of 1ml, hour limit of 10ml/h,and lock out time of 3min were set. The following indexes were recorded respectively at 24,48 and 72 hours after the PCA pumps were used:the VAS scores of pain; sedation score; demanded delivery and effective delivery; MAP, HR, RR, SPO 2, and side effects. Results: There was significant difference between Group ivPCA and Group scPCA in onset of analgesia ( P <0.05). No significant difference was found between the two groups in the VAS scores of the pain and side effects. Equipment accidents in Group scPCA were significantly less than that in Group ivPCA (5 equipment accidents in Group ivPCA were found)( P <0.05).Conclusion: No significant difference was found between the two groups in theraputic and side effects. Morphine scPCA excels morphine ivPCA in its simple operation, low accident rate, and longer possible application time.