PCA评价体表电刺激对心外科术后疼前疗效的对照研究

心外科术后疼痛不仅给病人带来痛苦，也会影响全身各系统的功能，甚至会导致肺不张、心衰竭等严重的并发症。临床上通常采用麻醉性镇痛药或局麻药区域阻滞缓解术后疼痛，但这两类药物均存在一定的副作用及并发症。近年来，体表神经电刺激（ｔｒａｎｓｃｕｔａｎｅｏｕｓ ｅｌｅｃｔｒｉｃ ｎｅｒｖｅ ｓｔｉｍｕｌａｔｉｏｎ，ＴＥＮＳ）开始用于心脏外科手术后镇痛，但有关研究常得出相互矛盾的结果。本工作以病人自控镇痛（ｐａ     

开胸术后病人应用自控镇痛泵对血氧饱和度的影响

[目的]比较开胸手术后病人应用自控镇痛泵与传统肌肉注射盐酸哌替啶对血氧饱和度的影响。[方法]选择126例开胸行贲门癌、食管癌根治术病人，术前检查肺功能正常。随机将126例分为肌肉注射盐酸哌替啶组（D组）和应用自控镇痛泵组（PCA组）。D组病人感觉疼痛时肌肉注射盐酸哌替啶镇痛；PCA组由病人或家属自行调节镇痛泵镇痛，每次间隔时间至少5min。术后回病房即刻、2h、4h、8h、12h、24h、48h观察疼痛、血氧饱和度（SpO2）、平均动脉压（MAP）、心率（腿）、呼吸频率（RR）、不良反应及术后7d随访肺部并发症情况。[结果]术后0h～48h比较SpO2两组差异无统计学意义，PCA组疼痛评分明显低于D组（P〈0．05）。术后7d肺部并发症PCA组2例，D组11例。[结论]PCA用于肺功能正常的贲门癌、食管癌根治术后镇痛，对SpO2无影响，镇痛效果明显，肺部并发症发生率低。     

PCA术后镇痛存在问题及对策

疼痛是最大程度的不舒适,术后急性疼痛已成为术后并发症和病死率增多的重要因素。1968年Sechzer提出“按需镇痛”的理念。1976年第一台病人自控镇痛泵（patient—controlled analgesia,PCA）问世。术后病人常采用PCIA（静脉PCA）和PCEA（硬膜外PCA）给药。与传统的肌内注射、口服给药等镇痛方法比较,     

颌面部手术后病人自控镇痛的护理

目的：探讨颌面部手术后病人自控镇痛的效果。方法：报告254例颌面部手术后自控镇痛（Patient-Controlled Analgesia PCA）方法的镇痛效果及护理，即术前PCA知识宣教；心理护理；PCA管理；术后镇痛指导；观察用药后反映及疼痛情况；儿童PCA的应用。结果：按照WHO疼痛分级标准，全部病人镇痛优良率达96．9％。结论：采用静脉PCA安全有效可靠，使用芬太尼作为主要镇痛液，对呼吸、血压影响很小，对颌面部术后病人更为有利，减少了护士的心理压力和工作量，避免病人的再次创伤，使镇痛达到理想效果。     

老年肝硬化门脉高压病人术后自控镇痛对血氧饱和度的影响及镇痛效果

目的：比较老年肝硬化门脉高压病人术后自控镇痛（PCA）与传统的肌肉注射哌替啶镇痛对血氧饱和度（SpO2）的影响和临床效果。方法：40例在全麻下行胃底贲门周围血管断流术的老年患者，术前检查肺功能正常，分为肌注哌替啶组（D组）和病人自控镇痛组（PCA组）。D组患者术后感觉疼痛时肌注哌替啶镇痛，PCA组由病人或家属自行静注吗啡镇痛。每次间隔时间至少15min。术后回病房即刻，4、8、12、24、48h进行随访并记录镇痛评分、SpO2、平均动脉压、心率、呼吸频率及不良反应等，术后7d随访肺部并发症情况。结果：术后0-48h比较，两组SpO2差异无显著性，PCA组疼痛评分明显低于D组（P〈0．05或P〈0．01）。术后7d肺部并发症D组有2例，而PCA组无一例（P〈0．01）。结论：静脉PCA用于肺功能正常的老年胃底贲门周围血管断流术后镇痛，对SpO2无影响．镇痛效果明显，肺部并发症发生率低，优于传统的肌注哌替啶方法，是一种用于老年肝硬化门脉高压病人手术后镇痛更为理想的方法。     

脊柱侧弯术后应用病人自控镇痛泵镇痛的护理研究

脊柱侧弯手术病人创伤大，疼痛剧烈，而且多为青少年，自控能力差，术后主动配合困难，给术后的护理工作带来很多困难，传统的术后镇痛法是根据病人的需要间断肌肉注射或持续静脉输注止痛药，镇痛效果难以令人满意。病人自控镇痛（patien tcontrolled analtesia，PCA）法因疗效确切，用药合理，注重镇痛的个体化，有助于术后镇痛，自20世纪90年代以来已广泛应用于临床。我科针对脊柱侧弯手术病人术后使用PCA泵，在护理工作方面做了一些研究，取得了较满意的临床效果。现报告如下。     

骨科手术后病人自控镇痛与肌肉注射镇痛药术后镇痛效果的比较

对50例骨科手术病人术后分别使用病人自控镇痛（PCA）和肌注镇痛药进行镇痛效果比较，选取了恶心、呕吐、镇静、疼痛和VAPS评分5个项目，结果显示PCA的止痛效果比肌肉注射更好，但PCA在恶心，呕吐、镇静三个项目上与肌注无显著差异。     

静脉PCA硬膜外PCA于肺癌术后镇痛效果比较

肺癌根治术后切口疼痛剧烈,不仅增加病人痛苦,影响肺通气功能的表达,而且影响病情的转归。术后自控镇痛（PCA）技术已广泛应用于临床,通过镇痛,使病人术后能积极配合转动体位,自主排痰,加大呼吸幅度,有效防止并发症发生。本文对肺癌术后病人自控硬膜外镇痛（PCEA）与病人自控静脉镇痛（PCIA）的有效性进行观察及分析,以便为临床护理提供借鉴。     

术后镇痛对C-反应蛋白和血清淀粉样A蛋白的影响

目的探讨食管癌术后有效镇痛是否可以降低患者手术及疼痛引起C-反应蛋白（CRP）和血清淀粉样A蛋白（SAA）的应激反应。方法20例ASAⅠ-Ⅱ级，无免疫系统疾病的食管癌患者，根据镇痛方法的不同随机分为两组。肌注哌替啶（D）组、病人自控镇痛（PCA）组，监测患者术后血压、心率（HR）、呼吸（RR）、血氧饱和度（SpO2）、疼痛评分（VAS）和患者对镇痛效果的满意度。检测患者围麻醉期CRP和SAA水平。结果PCA组患者对镇痛效果的满意度明显高于D组，VAS评分则明显低于D组（P〈0．05）。两组CRP术后均略有升高，但升高幅度略低于文献报道。SAA在镇痛效果良好的PCA组明显下降。结论术后疼痛是外科创伤后引起CRP和SAA敏感反应的原因之一。术后有效镇痛有助于维持患者内环境的稳定，降低手术后疼痛引起的应激反应。     

应用硬膜外镇痛泵病人的护理

病人自控镇痛术（patient—controlled analgesia，PCA）是一种新开展的技术，使用的是一次性输注泵，分为静脉镇痛泵（PCI—A）和硬膜外镇痛泵（PCEA）。该泵是由微量流量控制管控制药液流速，达到按需止痛，且有自控加药功能，即病人可根据疼痛情况自主加药。由于该泵操作简单、体积小、便于携带等优点，越来越普遍地应用于临床术后病人的镇痛。我院自2001年开始使用，PCEA取得较好的效果，但也出现了一些并发症，病人对此不满意。因此，对此类病人应加强术前、术后的心理护理及相应的护理措施，可有效止痛，从而提高病人镇痛的满意率。     

普外科大手术后患者自控镇痛效果的观察

目的 探讨普外科大手术后患者自控镇痛的护理，为改善镇痛效果、减轻患者痛苦提供实践依据。方法 选取2002年6月至2005年12月间普外科大手术患者210例，其中108例采用自控镇痛（patient controlled analgesia，PCA），102例采用传统方法镇痛，观察两组患者术后镇痛效果的差异。结果自控镇痛有效率为93．5％，镇痛效果明显优于传统镇痛（P〈0．01）。结论 自控镇痛在普通外科大手术后镇痛效果良好，减少患者术后痛苦，有助于提高患者的生存质量。     

TENS and Pain Control after Coronary Artery Bypass Surgery

This paper describes a randomised controlled trial to evaluate the effectiveness of TENS in controlling pain following coronary artery bypass grafting (CABG). A total of 59 men undergoing CABG with internal mammary artery (IMA) at Bristol Royal Infirmary were randomly allocated to receive TENS or placebo in conjunction with patient-controlled analgesia (PCA) for one hour on their first postoperative day. A visual analogue pain score and the hourly usage of the PCA were recorded before, during and after the application of TENS or placebo. The results show that although pain scores were significantly reduced in the hour in which TENS was applied, there was no significant difference in this reduction between the TENS and placebo groups. PCA use by patients during the study period was limited, with the majority making none or one successful request per hour. The results imply that the observed reductions in pain were due to a placebo effect and that the use of TENS in conjunction with PCA following CABG with IMA is unlikely to confer a clinically important reduction in post-operative pain.     

Acupoint Stimulation to Improve Analgesia Quality for Lumbar Spine Surgical Patients

Lumbar spine surgery has a high incidence of postoperative pain, but this pain is treatable through many methods, including patient-controlled analgesia (PCA). Acupoint stimulation could be considered an adjunct to PCA, improving the effectiveness of analgesia for patients recovering from lumbar spine surgery. The current study aimed to examine the effect of acupoint stimulation with PCA on improving analgesia quality after lumbar spine surgery. A single-blinded, sham-controlled design was used for the experimental, not control, groups. Data collection for the control group was completed first, followed by data collection for the other 2 groups. Participants were randomly assigned to the acupoint stimulation (AS) (n = 45) or sham group (n = 45). All participants received structural PCA multimedia information before lumbar surgery. The AS group received auricular acupressure combined with transcutaneuos electric acupoint stimulation (TEAS) at the true acupoint; the sham group received acupoint stimulation in the same manner but at a sham acupoint and without embedding seeds; and the control group received no acupoint stimulations. The analgesia quality, analgesic consumption, and postoperative nausea and vomiting (PONV) were used as measure of effects for the interventions. Significant differences were found between the AS and control groups in pain intensity but not in the belief and satisfaction subscales of analgesia quality. Also found a significant difference among the 3 groups in analgesic consumption and the severity of PONV in the first 72 hours after surgery. The current study shows that the combination of auricular acupressure and TEAS reduced pain intensity, morphine consumption, and PONV severity. Acupoint stimulation could be considered a multimodal analgesia method and an adjunct to PCA for lumbar spine surgery patients.     

Pain relief after low back surgery: the efficacy of transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS) was used for the relief of post-operative pain following low back surgery in a consecutive series of over 157 patients. A comparative study of the use of post-operative narcotic analgesics by 52 of these patients (26 in each of two groups) was made to determine the effectiveness of TENS in relieving post-operative pain. Fifty per cent of the sample used analgesics only; 50% used TENS in addition to analgesics. The data collected included its frequency of post-operative analygesic use, a rank order of analgesic potency, and a post-operative "pain score" derived from the combination of analgesic potency and frequency of use. Data analysis revealed significant differences between the groups in the use of analgesics. TENS decreased the need for narcotics in the relief of post-operative pain following low back surgery, although it is not a replacement for post-operative medication.     

Intrathecal morphine after cardiac surgery

OBJECTIVE: To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections. METHODS: Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes. RESULTS: ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups. CONCLUSIONS: Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.     

低剂量氯胺酮超前镇痛应用于开胸手术的临床研究

目的探讨开胸手术应用低剂量氯胺酮的效果及副作用。方法 60例择期开胸手术患者按随机、双盲原则分为对照组和氯胺酮组各30例。氯胺酮组切皮前5 min静脉注射氯胺酮0.15 mg/kg,后持续泵注氯胺酮0.2 mg/(kg.h)至手术结束;对照组相应静脉注射和泵注生理盐水,术后经静脉患者自控镇痛(PCIA)。分别于术后72小时内各时间点观察患者的视觉模拟评分(VAS评分),记录PCA泵总按压次数、有效按压次数及曲马多用量与副作用。术后电话随访疼痛情况,了解慢性疼痛发生率。结果术后各时间点VAS评分差异无统计学意义(P>0.05);氯胺酮组PCA泵总按压次数、有效按压次数及曲马多用量较对照组少(P<0.05);术后电话随访两组慢性疼痛发生率差异无统计学意义(P>0.05)。苏醒期躁动、谵妄、恐惧、噩梦等不良精神反应和其他不良反应的发生情况,两组比较差异无统计学意义(P>0.05)。结论开胸手术给予低剂量氯胺酮,可以减少术后镇痛药的用量,但不能减少术后慢性疼痛发生率,氯胺酮超前镇痛的确切性仍有待研究。     

坐骨神经切断大鼠脑脊液中CCK-8含量的动态变化及其与吗啡镇痛的关系

目的：研究神经源性疼痛时吗啡镇痛效应的降低与中枢八肽胆囊收缩素(CCK-8)的释放量之间的关系。方法：以切断大鼠单侧坐骨神经作为引起神经痛的动物模型，用放射免疫分析法，观察术后第3，7，10和14天脑脊液中CCK-8-ir含量的变化，并在相应的时间点分别皮下注射吗啡(4mg／kg)和CCKB受体拮抗剂L-365，260(0．5mg,／kg)，观察痛阈(辐射热甩尾潜伏期)的变化。结果：(1)大鼠单侧坐骨神经切断后一周，脑脊液中CCK-8样免疫活性物质(CCK-8-ir)的浓度(代表中枢CCK-8的释放量)增加了125％，此时吗啡的镇痛效果降低，而CCK拮抗剂使吗啡镇痛效果提高。(2)坐骨神经切断后1．5～2周，中枢CCK-8释放减少或保持正常水平，此时吗啡镇痛效果正常，CCK拮抗剂也不能使其效应进一步提高。(3)假手术组大鼠于第14天(第四次注射吗啡)时，吗啡作用减弱(发生耐受)，此时CCK拮抗剂显示出对吗啡镇痛的加强作用。结论：单侧坐骨神经切断后一周吗啡镇痛效果减弱，可能与当时中枢CCK-8释放过多有关。切断坐骨神经后中枢释放CCK-8水平的变化，是影响阿片镇痛的重要因素。     

Einfluss negativer Stressverarbeitung auf postoperatives Schmerzerleben und -verhalten

OBJECTIVE: The aim of the study is to show whether negative coping style has an impact on post-operative pain reporting and pain-related behaviour. METHODS: After informed consent 48 gynaecological patients were enrolled in the study. Negative coping style was assessed by using the stress coping questionnaire SVF-78 (Janke and Erdmann). Patients were dichotomised by scores of the negative coping style. Pain reporting concerned pain intensity and pain quality. Pain-related behaviour was assessed by patient-controlled analgesia (PCA). Pain intensity and pain quality were assessed prior to surgery and 24 h after surgery. Patient-controlled analgesia was recorded up to 24 h after surgery. Trait anxiety (STAI-X2) was used as a control variable. RESULTS: Patients with high scores in negative coping style report increased levels of pain in both affective and sensory pain perception. At the same time patient-controlled analgesia is used less frequently by this group. This result remains significant considering trait anxiety as a covariate. CONCLUSIONS: High negative coping style may cause a discrepancy between pain reporting and pain-related behaviour. This should be taken into account in the perioperative care of patients.     

术前口服曲马多在神经外科手术超前镇痛的应用

目的:观察颅脑手术病人术前口服不同剂量曲马多对术后镇痛的效果以及副作用的发生率,探讨曲马多用于神经外科手术超前镇痛的合理用量.方法:采用随机、双盲、平行对比的研究方法,择期神经外科全麻颅脑手术患者175例,随机分为三组:安慰剂组、曲马多100mg组、曲马多200mg组.各组药物分别于术前2h口服.所有病人术后采用相同剂量的曲马多PCA镇痛.于术后48h内定时观察VAS疼痛评分,记录镇痛药用量、副作用.结果:术后VAS疼痛评分各组间无统计学差异,术后4h内安慰剂组疼痛例数高于超前镇痛组(P＜0.05).口服曲马多各剂量组术后恶心呕吐发生率以曲马多200mg组较高.结论:口服曲马多用于神经外科手术有明确的超前镇痛作用,术前口服曲马多100mg术后镇痛效果好,术后恶心及呕吐发生率较低,是较适宜的术前口服剂量.     

Efficacy of patient-controlled analgesia for management of pain after abdominal operations.

In order to control pain during the early post-operative period, patient-controlled analgesia (PCA) with buprenorphine as an analgesic drug was applied in 23 patients undergoing abdominal operations. With this "on demand" system, the patient was allowed to self-administer narcotic analgesic medication using a programmable infusion pump. Overdose could be minimized with a mandatory lock-out interval between allowable injections. Average total requirement of buprenorphine was 0.355 mg at 48 hr after operation. Nineteen of the 23 (82.6%) patients characterized their pain control as "excellent" or "good". In these patients there existed high correlation between the total number of patient attempts and the number of successful injections. The PCA system was thought to provide improved pain relief at smaller total drug dosages. In addition, earlier and greater spontaneous physical activity was maintained with PCA therapy. The potential for overdose could be minimized, and thereby PCA appears to be an efficacious and safe method of providing for postoperative pain relief.