静脉与硬膜外泵注芬太尼病人自控镇痛的疗效评价

Efficacy evaluation of patient-controlled analgesia of intravenous or epidural fentanyl

目的 :比较术后静脉和硬膜外应用芬太尼病人自控镇痛 (PCA)的临床效果和安全性。方法 :40例经腹子宫切除术病人随机分为静脉注射芬太尼自控镇痛 (PCIA)组和经硬膜外注射芬太尼自控镇痛(PCEA)组 ,每组 2 0例。两组芬太尼负荷量都是5 0 μg。PCA药物配方为芬太尼 1 0 0 0 μg+氟哌啶5mg +0 .9%氯化钠至 1 0 0ml。持续给药注速1ml·h- 1 ,单次PCA剂量 1ml,锁定时间 1 5min。术后定时进行镇痛及镇静评分和患者满意度调查 ,观察 48hPCA需求按压和有效按压次数 ,以及芬太尼用量和不良反应。结果 :PCIA组 48h内药物用量、需求按压和有效按压次数均明显少于PCEA组 (P <0 .0 5 )。两组病人均可取得满意的镇痛和镇静效果 ,在PCA泵使用后 1 2h内 ,PCIA组视觉模拟法(VAS)疼痛评分及Ramesay镇静评分与PCEA组有显著差异 (P <0 .0 5 )。两组不良反应发生率无明显差异。PCIA和PCEA组病人对术后镇痛的总体满意度分别为 90 %和 85 %。结论 :芬太尼用于术后镇痛安全有效 。

AIM: To evaluate the efficacy and safety of patient controlled analgesia (PCA) of intravenous or epidural fentanyl. METHODS: 40 patients undergoing elective hysterectomy were randomly allocated to patient controlled intravenous analgesia (PCIA) group (n=20) and patient controlled epidural analgesia (PCEA) group (n=20). The PCA solution consisted of fentanyl 1 000 μg, droperidol 5 mg and NS 78 ml, loading dose of fentanyl 50 μg, background infusion 1 ml·h -1 , bolus 1 ml, and lockout time 15 min. The scores of pain and sedation, the number of PCA demand and delivery, fentanyl consumption, side effects and patient's satisfaction were assessed for 48 hours. RESULTS: The total dosage of fentanyl used, the number of PCA demand and delivery in 48 hours were obviously smaller in PCIA group than in PCEA group (P< 0.05 ). Two groups gained satisfactory pain relief and sedation, but during 12 hours after PCA pumps were used, significant differences were found between two groups on VAS and Ramesay sedation scores (P< 0.05 ). There was no marked difference on side effects between two groups. The overall satisfaction of the patients in two groups about postoperative analgesia was 90% in PCIA and 85% in PCEA, respectively. CONCLUSION: Fentanyl for postoperative pain relief is a safe and effective agent, but PCIA with fentanyl is better than PCEA with fentanyl for postoperative analgesia.