两种不同术后硬膜外腔自控镇痛方法的比较研究

目的比较两种不同术后硬膜外腔自控镇痛方法（PCEA）的镇痛效果、并发症情况以及应用成本。方法选择ASAⅠ～Ⅱ级在硬膜外麻醉下行下腹部手术患者80例,随机分为两组（Ⅰ组和Ⅱ组）,每组40例。全部患者于腰2～3间隙穿刺行联合腰硬麻醉,向上置入硬膜外导管,术毕保留导管行硬膜外腔自控镇痛。镇痛方法为：Ⅰ组硬外导管连接50 ml一次性注射器,Ⅱ组硬外导管连接一次性病人自控镇痛泵,两组均用同一配方镇痛药液。观察两组患者的镇痛效果,镇痛液用量和并发症情况,计算两种方法的应用成本。结果两组镇痛液用量比较,Ⅰ组明显低于Ⅱ组,差异有统计学意义[（56.0±9.5）ml vs（78.2±10.2）ml,P〈0.05];两组镇痛效果比较差异无显著性意义（P〉0.05）;两组并发症比较,Ⅰ组低血压发生率高于Ⅱ组（P〈0.05）,Ⅰ组恶心呕吐和尿潴留的发生率低于Ⅱ组（P〈0.05）;应用成本Ⅰ组明显低于Ⅱ组[（73.5±12.4）元vs（258.5±21.8）元,P〈0.05]。结论通过硬外导管连接一次性注射器或一次性病人自控镇痛泵,行PCEA均可取得满意的镇痛效果,但前者用药量少,应用成本低,低血压并发症较多;后者用药量大,应用成本大,恶心呕吐和尿潴留并发症较多。

Comparative Study on Two Different Methods of Postoperative Epidural Patient-Controlled Analgesia

Objective To compare the analgesia effect,complication and application cost of two different methods of postoperative epidural patient-controlled analgesia.Methods 80 patients scheduled for lower abdominal surgery under combined spinal epidural anesthesia whose ASA status were Ⅰ ~ Ⅱ were randomly assigned into two groups（groupⅠ and group Ⅱ,n = 40）.The combined spinal epidural anesthesia was lumbar punctured at patients＇ L2 and L3 gap and the catheter was put into epidural space upward and maintained for postoperative patient-controlled analgesia.The epidural catheter connected with a disposable 50 ml syringe in groupⅠand with a disposable 100 ml PCA pump in group Ⅱ.The analgesia solution formula was the same in both groups.The analgesia effect,analgesia solution consumption and the complication were observed and the application cost of two methods was calculated.Results The analgesia solution consumption in groupⅠwas lower than that of in group Ⅱ [（56.0 ± 9.5） ml vs（78.2 ± 10.2） ml,P 0.05].The analgesia effect was the same in both groups（P 0.05）.As for complication,the incidence of hypotension in group Ⅰ was higher than that of in group Ⅱ（P 0.05）,while the incidence of nausea or vomiting and urinary retention in group Ⅰ were lower than those of in group Ⅱ（P 0.05）.The application cost in group Ⅰ was lower than that of in group Ⅱ [（73.5 ± 12.4） yuan vs（258.5 ± 21.8） yuan,P 0.05].Conclution The same postoperative analgesia effect was achieved with epidural patient-controlled analgesia facilitated via epidural catheter connecting with a disposable syringe or with a disposable PCA pump.But the lower analgesia solution consumption,the higher incidence of hypotension and the lower application cost were found in the former method while the higher analgesia solution consumption,the higher incidence of nausea or vomiting and urinary retention and the higher application cost were found in the latter.