智能化管理系统对剖宫产术后静脉自控镇痛期间适宜随访时机的选择

Effect of intelligence management system on choosing the best timing of follow-up for women after cesarean de-livery with PCIA

目的通过智能化病人自控镇痛(Ai-PCA)及其管理系统,探索剖宫产术后镇痛期间的适宜随访时机.方法通过智能化管理数据库,收集行腰硬联合麻醉剖宫产手术,并采用术后静脉自控镇痛(PCIA)的产妇102例,采用地佐辛(0.5 mg/kg)、氟比洛芬酯(150 mg)和多拉司琼(25 mg)稀释至120 mL,采用LCP模式,负荷剂量为5 mL,持续输注剂量为2 mL/h,单次自控按压剂量为2 mL,锁定时间15 min,极限量12 mL/h.观察产妇按压镇痛泵的时间及次数、疼痛评分、镇静程度评分和术后恶心呕吐(PONV)发生情况.结果与术后当天和术后第2天相比,产妇术后第1天按压止痛泵次数和术后疼痛评分显著增加(P<0.05),术后镇静水平显著降低(P<0.05).在PONV发生率方面,术后第1天的PONV发生率(42.2%)也明显高于术后当天(11.8%)和术后第2天(13.8%)的水平;而与术后第2天相比,术后当天和术后第1天PONV严重程度显著升高(P<0.05).术后第1天,2~4时和8~10时两个时间段止痛泵按压次数较多.结论采用腰硬联合麻醉剖宫产术后PCIA的产妇,术后第1天镇痛药物需求量更大,按压PCA次数最多,术后第1天8时前随访更为合理,有利于改善镇痛效果.

Objective To investigate the best timing for follow-up via artificial intelligence patient-controlled analgesia(Ai-PCA)and its management system for women after cesarean delivery.Methods By using a database of a smart pain management system,102 women after cesarean delivery with spinal-epidural anesthesia were included.The women received patient-controlled intravenous analgesia(P C IA)to relieve postoperative pain.We used dezocine(0.5 m g/k g),flurbiprofenaxetil axetil(150 mg)and dolasetron(25 mg)in com bination,and the total volume of the 3 drugs was diluted into 120 mL.The LCP model was chosen,with the loading dose(LD)of 5 m L,the continuous infusion volume of 2 mL/h,and the bolus volume of 2 mL.The minimal time interval was 15 min between two presses.The maximal infusion volume was modified to 12 mL/h.The total press times,the postoperative pain degree,sedation score,incidence of postoperative nausea and vomiting(PONV)and the PONV degree were assessed.Results Compared with on Day 0 and 2,significantly more anesthesia boluses were required on Day 1,with significantly higher pain degree and lower sedation score(P<0.05).The incidence of PONV on Day 1(42.2%)was significantly higher than that on Day 0(11.8%)and 2(13.8%).The PONV score on Day 2 was significantly lower than those on Day 0 and 1(P<0.05).During Day 1,the total press times during 2-4 o'clock and 8-10 o'clock were higher.Conclusion Women with spinal-epidural anesthesia undergoing cesarean delivery need more analgesics,and before 8 o'clock on Day 1 is more reasonable for follow-up to ameliorate the analgesic effect.