子宫切除术后皮下与硬膜外自控镇痛的临床效应.pdfVIP

2008年2月第5卷第6期 · I 床研究 · 子 宫切除术后皮下与硬膜外自控镇痛的临床效应 吴世民 ．张成伟。 (1．深圳市福永人民医院麻醉科，广东深圳 518103；2．华中科技大学同济医学院附属同济医院麻醉学教研室，湖北武汉 430030) 【摘要】目的：比较子宫全切术后芬太尼用于病人自控皮下镇痛与硬膜外镇痛的临床效应。方法：选择全麻下子宫 全切术病人60例，术后病人行自控皮下镇痛(PCSA)和硬膜外镇痛(PCEA)，并根据不同的镇痛方法随机分为两 组：皮下镇痛组(S组)和硬膜外镇痛(E组)，每组30例。S组配方为芬太尼1 mg+利多卡因150 mg，E组为芬太尼 0．5 mg+布比卡因150 mg，两组均加生理盐水稀释到100 ml。术后48 h内采用视觉模拟评分(VAS)、PCA按压次 数、镇痛满意度评分来观察各组镇痛效应，并记录恶心、呕吐、皮肤瘙痒等不良反应的发生率。结果：两组病人术后 48 h内的视觉模拟评分(VAS)、PCA按压次数、镇痛满意度以及不良反应发生率等的比较，差异无统计学意义( 0．05)，而E组恶心呕吐、尿潴留和局部反应的发生率显著高于S组(P0．05)。镇痛期间无呼吸抑制等严重并发症 的发生。结论：病人自控皮下镇痛与硬膜外镇痛用于子宫全切术后均可取得满意的镇痛效果，而皮下镇痛实际应 用时更为方便且不良反应少。 【关键词】皮下注射；硬膜外注射；镇痛；病人控制；子宫全切术 【中图分类号】R614 【文献标识码1 A 【文章编号】1673-7210(2008)02(c)一059—02 Clinical effect of subcutaneous and epidural patient-controlled analgesia in total hysterectomy patients WU Shi—min1,ZHANG Xian—wei (1．Department of Anesthesiology，Fuyong People’S Hospital，Shenzhen 5 1 8 1 03，China；2．Department of Anesthesiology， The Affiliated Tongji Hospital of Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430030，China) [Abstract]Objective：To comp~e the analgesic efficacy and complications of epidural and subcutaneous patient-con— trolled analgesia(PCA)of fentanyl mixed with local anesthetics in postoperative total hysterectomy patients．Methods：60 patients undergoing total hysterectomy in general anesthesia were randomly divided into two groups with thirty cases in each：subcutaneous analgesia group(S)and epidural analgesia group∞．The mixture of~nmnyl 1 mg and lidocaine 1 50 mg was administered in group S，while the mixture of fentanyl 0．5 mg and bupivacaine 150 mg was used in group E．The vi— sual analog scale(VAS)，times of PCA，patient’S satisfaction and incidence of side effects were recorded