摘要
目的比较不同镇痛模式在吻合器痔上黏膜环切(PPH)术后镇痛中的效果。方法选择拟于腰硬联合麻醉下择期行PPH术患者60例,完全随机均分为静脉自控镇痛(PCIA)组与硬膜外自控镇痛(PCEA)组,每组30例。PCIA组:舒芬太尼100μg+托烷司琼10 mg+0.9%氯化钠注射液至100 m L术后静脉注射,背景输入剂量为2 m L·h-1,单次PCA量为1 m L,间隔时间15 min; PCEA组:0.179%甲磺酸罗哌卡因+舒芬太尼40μg+0.9%氯化钠注射液至200 m L术后硬膜外注射,背景输入剂量4 m L·h-1,单次PCA量为2 m L,间隔时间15 min,每日静脉注射托烷司琼5 mg。观察并记录术后6,12,24,48 h的Ramsay镇静评分、视觉模拟疼痛(VAS)评分、舒适评分(BCS)、改良Bromage分级。记录PCA24,48 h内实际按压次数和有效按压次数。记录术后并发症发生情况。结果术后12,24 h时,PCIA组Ramsay镇静评分、VAS评分明显高于PCEA组,BCS评分明显低于PCEA组(P<0.05);术后6 h时,PCIA组Bromage分级明显低于PCEA组(P<0.05)。术后24,48 h PCIA组实际按压次数、有效按压次数明显多于PCEA组(P<0.05)。PCIA组发生术后恶心、呕吐5例,明显多于PCEA组(P<0.05)。结论 PCEA用于PPH术后镇痛,可提供良好的舒适度,优于PCIA。
Objective To evaluate the different analgesia mode for pain control in patients who undergo a procedure for prolapse and hemorrhoids.Methods Sixty patients who were undergoing the procedure for prolapse and hemorrhoids with combined spinal epidural anesthesia were randomized into two groups(30patients each group).Group PCIA had the patient-controlled intravenous analgesia with sufentanil100μg and tropisetron10mg with0.9%sodium chloride soution to100mL,the input background dose was2mL·h^-1,the single PCA was1mL,the time interval was15min.Group PCEA had the patient-controlled epidural analgesia with0.179%ropivacaine mesylate and sufentanil40μg with0.9%sodium chloride soution to200mL,the input background dose was4mL·h^-1,the single PCA was2mL,the time interval was15min,daily intravenous administration of tropisetron5mg.Recorded the Ramsay sedation score(RSS),the visual analogue scale(VAS),the comfortable satisfaction score(BCS)well as the improved Bromage classification at6,12,24and48hours after surgery.The frequencies of actual and effective pressing were also observed at the time point of24and48hours after surgery.Postoperative complications,including pruritus,nausea,headaches,and urinary retention,were also recorded.Results Compare to group PCEA,the Ramsay sedation score and the VAS score were significantly higher and the comfortable satisfaction score was significantly lower in group PCIA at12,24h after the surgery(P<0.05),the improved Bromage classification was significantly lower in group PCIA at6h after the surgery(P<0.05).At the time of24,48h after the operation,the frequencies of actual and effective pressing were significantly higher in group PCIA than those in group PCEA(P<0.05).Complications were more common in group PCIA,five patients presented postoperative nausea and vomiting(P<0.05).Conclusion The PCEA could provide more comfortable better postoperative analgesia and more comfortable than the PCIA for patients undergoing the procedure for prolapse and hemorrhoids.
作者
孔亮
孟秀荣
陈永军
李德刚
李桂英
张建林
纪伟
周洪
KONG Liang;MENG Xiurong;CHEN Yongjun;LI Degang;LI Guiying;ZHANG Jianlin;JI Wei;ZHOU Hong(Department of Anesthesiology, Changping Hospital of Traditional Chinese Medicine of Beijing City, Beijing 102200, China;Department of General Surgery, Changping Hospital of Traditional Chinese Medicine of Beijing City, Beijing 102200, China)
出处
《医药导报》
CAS
北大核心
2019年第1期71-74,共4页
Herald of Medicine
关键词
舒芬太尼
罗哌卡因
甲磺酸
镇痛
术后
静脉自控镇痛
硬膜外自控镇痛
痔上黏膜环切术
Sufentanil
Ropivacaine mesylate
Analgesia, postoperative
Patient-controlled intravenous analgesia
Patient-controlled epidural analgesia
Procedure for prolapse and hemorrhoids
