蛛网膜下腔注入小剂量吗啡术后镇痛与PCEA比较研究

Comparison among Intrathecal Injection of Morphine and PCEA for Postoperative Analgesia

目的 :探讨蛛网膜下腔小剂量吗啡术后镇痛的临床效果并与 PCEA相比较。方法 :将 ASA I～II级 6 0例妇科择期手术患者 ,随机分为两组 ,每组 30例。实验组采用腰麻 ,局麻药为 0 .75 %布比卡因 10～ 15 m g加入吗啡 0 .5 mg。对照组采用腰麻复合 PCEA,局麻药 0 .75 %布比卡因 10～ 15 mg,术后 PCEA。术后镇痛效果以视觉模拟评分 (VAS)、Ram say镇静评分、BCS舒适评分、成功率、不良反应并结合医疗费用比进行评价。结果 :VAS评分两组在 4、8、36 h时段无显著性差异 (P>0 .0 5 ) ;实验组在 12、2 4 h镇痛效果优于对照组 ,4 8、5 4 h对照组优于实验组。 BCS舒适评分、Ram say镇静评分两组间无显著性差异。结论 :蛛网膜下腔注入小剂量的吗啡用于术后镇痛的效果并不亚于 PCEA,如采用医疗费用与治疗效果比 。

Objective:To study the analgesic effects of intrathecal injection of mophine for postoperative pain relief and compare it with PCEA.Methods:Sixty ASA Ⅰ~Ⅱ patients were randomly divided into two groups.Intathecal group(group s),the patients(n=30) received a spinal injection of bupivacaine with morphine 0.5 mg and control group (group C)( n =30),received a spinal injection of bupivacaine with PCEA.The effects of postoperative analgesia were assessed with the visual analogue scale(VAS),Rmsay sedation scores and Breggrmann comfort scale at 4,8,12,24,36,48 and 54 hours after operation.Results:The VAS was less in group S than that in group C at 12 and 24 hours and was more at 48 and 54( P <0.05).There were no significant changes between the two groups in Ramsay sedation scores and Breggrmann comfort scale.Conclusion:The effect of intrathecal injection of morphine for postoperative analgesia is not inferior to PCEA.According to the fee for service,the former is much more excellent than the latter.