镇静对前列腺电切术后静脉自控镇痛患者舒适度和满意度的影响

Effect of sedation on comfort and satisfaction of patients with intravenous analgesia after prostatectomy

目的:探讨经尿道前列腺电切术(TURP)后行静脉自控镇痛(PCIA)的患者在轻度疼痛范围内不同镇静程度对患者舒适度和满意度的影响。方法:收集择期蛛网膜下腔神经阻滞麻醉下行TURP患者203例,年龄60~75岁,ASA分级Ⅰ~Ⅲ级,分为试验组和对照组,试验组患者术后佩戴镇痛泵,术后视觉模拟评分(VAS)评分≤3分,依据Ramsay镇静评分(6分法),将镇静评分1~4分患者分为1分组、2分组、3分组和4分组,对照组患者术后不做任何处理,采用Likert-5级满意度评分法及BCS舒适度评分法在术后6、24 h对患者进行满意度和舒适度评分,并观察记录患者不良反应的发生情况。结果:试验组患者的舒适度和满意度明显高于对照组,术后6、24 h Ramsay镇静评分2分组患者舒适度和满意度最高,并且不良反应发生最少,与其他组比较差异有统计学意义(P<0.05);3分组次之,患者的满意度与舒适度均高于1分组和4分组;4分组患者舒适度和满意度最低;各组间比较差异有统计学意义(P<0.05)。术后不良反应1分组发生率最高,4分组次之,均高于2分组、3分组和对照组,组间比较差异有统计学意义(P<0.05);但1分组和4分组比较差异无统计学意义(P>0.05),2分组、3分组和对照组比较差异无统计学意义(P>0.05)。试验组和对照组患者均未出现明显的尿潴留、呼吸抑制及意识障碍等其他不良反应。结论:TURP术后6、24 h的PCIA患者,在轻度疼痛范围内,镇静评分为2分的患者舒适度和满意度最高,且术后不良反应发生率最小。

Objective:Within an acceptable range of mild pain,to investigate the effects of different levels of sedation of patient control intravenous analgesia(PCIA)on comfort and satisfaction in patients with PCIA after TURP surgery.Method:A total of two hundred and three patients were selected,aged range for sixty to seventy-five years old.They all underwent elective transurethral resection of the prostate under spinal anesthesia with ASA ratingⅠ-Ⅲ.They were divided into experimental group and control group.The experimental group was treated with analgesia pump after operation,and their visual analog score(VAS)score was≤3 points.According to Ramsay sedation score(6 points),patients with sedation scores of four points and below were divided into score one group,score two group,score three group and score four group.The control group did not receive any analgesic treatment postoperatively.The satisfaction and comfort scores were scored at 6 h,24 h after operation using the Likert-five satisfaction score and BCS comfort score.The incidence of adverse reactions was recorded.Result:The comfort and satisfaction of the experimental group were significantly higher than those of the control group.The comfort and satisfaction of the Ramsay sedation score two group were the highest at 6 h,24 h after operation,and the difference was statistically significant(P<0.05).While Ramsay sedation score four group patients had the lowest comfort and satisfaction,and the difference was statistically significant compared with the other groups(P<0.05).The incidence of adverse reaction of score one group was the highest,followed by score four group,which were higher than score two and three groups and the control group.The difference among groups was statistically significant(P<0.05).But there was no significant difference between the score one group and four group(P>0.05).Also,it was not statistically significant among the score two,three group or the control group(P>0.05).There were no other adverse reactions such as urinary retention,respiratory depression or disturbance of consciousness in the five groups of patients.Conclusion:In patients with PCIA at 6 h,24 h after TURP surgery,the comfort and satisfaction rate of score two group were the highest,and the incidence of adverse reactions was the least.