摘要
目的:比较连续肌间沟臂丛神经阻滞与静脉自控镇痛用于肩关节镜手术术后镇痛的效果和不良反应。方法选择40例ASA分级Ⅰ~Ⅱ级全身麻醉下行择期肩关节镜手术的患者,采用随机数字表法分为两组,每组20例。分别为连续肌间沟臂丛神经阻滞组(PCNA组)和静脉自控镇痛组(PCA组)。两组术后均接自控镇痛泵。PCNA组采用0.2%罗哌卡因十0.9%氯化钠注射液至100 mL,背景参数为4 mL/h,单次量0.5 mL,锁时20 min,术后24 h加药。PCA组采用芬太尼1 mg+托烷司琼5 mg+0.9%氯化钠注射液至100 mL,背景参数为2 mL/h,单次量3.5 mL,锁时时间定为20 min。记录比较手术结束后6 h,12 h,24 h,48 h患者VAS疼痛评分,以及术后头晕、恶心、呕吐及皮肤搔痒等不良反应情况,48 h后患者镇痛满意度调查。结果PCNA组术后各时点VAS评分明显低于PCA组(P<0.05)。PCNA组术后头晕、恶心、呕吐的发生率低于PCA组,差异有统计学意义(P<0.05)。PCNA组的患者满意度为100%,PCA组的患者满意度为75%,差异有统计学意义(P<0.05)。结论连续肌间沟臂丛神经阻滞应用于肩关节镜手术术后镇痛的镇痛效果和患者满意度都优于静脉自控镇痛,且头晕、恶心、呕吐的发生率较低,可供临床使用。
Objective To observed the analgesia and adverse reactions of continuous patients-controlled in-terscalene analgesia with patient-controlled intravenous analgesia for the shoulder arthroscopic surgery.Methods 40 patients with ASAⅠ~Ⅱanesthesia in general anesthesia for the shoulder arthroscopic surgery were selected and randomly divided into the two groups,20 cases in each group.They were continuous patients-controlled interscalene analgesia(PCNA)and patient-controlled intravenous analgesia(PCA).PCNA with 0.2%ropivacaine+saline to 100mL,background parameters 4ml/h,a single dose of 0.5mL,lock 20min.24 hours after dosing.PCA with fentanyl lmg+tropisetron 5mg+saline to 100mL,background parameters 2mL/h,a single dose of 3.5mL,lock 20min.Record the VAS score 6h,12h,24h,48h after surgery,and adverse side effects of postoperative dizziness,nausea,vomiting and itchy skin.And the patient's analgesic satisfaction survey 48h after surgery.Results PCNA after surgery 6h,12h,24h,48h in VAS score was significantly lower than the PCA(P<0.05).PCNA were dizziness,nausea,vomiting and the incidence is lower than the PCA,the difference was statistically significant(P<0.05).The PCNA of patients sat-isfaction was 100%,the PCA of patients satisfaction is 75%,the difference was statistically significant(P<0.05).Conclusion In the postoperative analgesia of shoulder arthroscopic surgery,the analgesic effect and patient satisfac-tion of continuous patients-controlled interscalene analgesia are better than patient-controlled intravenous analgesia.And the dizziness,nausea,vomiting is lower.
作者
王晶
李大鹏
李俊玲
Wang Jing;Li Dapeng;Li Junling(Department of Anesthesiology,the 89th Hospital of Chinese People,s Liberation Army,Weifang,Shandong 261021,China)
出处
《中国基层医药》
CAS
2014年第S01期15-17,共3页
Chinese Journal of Primary Medicine and Pharmacy
关键词
镇痛
患者控制
关节镜检查
疼痛
手术后
臂丛
神经传导阻滞
Analgesia,Patient-Controlled
Arthroscopy
Brachial Plexus
Pain,Postoperative
Nerve Block
