术后硬膜外自控镇痛时等效剂量3种镇痛药临床效果比较

目的　评价术后硬膜外自控镇痛 (PCEA)时三种等效剂量麻醉性镇痛药 (吗啡、芬太尼、哌替定 )的镇痛效果及不良反应。方法　选择在硬膜外麻醉下完成腹部或腰椎间盘摘除手术的成年患者 90例 ,术后用硬膜外自控药镇痛泵治疗。按镇痛药将患者随机分成 3组 ,每组 30例 ,硬膜外自控镇痛 (PCEA)用药配制 ,Ⅰ组 :0 .12 5 %布比卡因 80ml+芬太尼 0 .1mg ,Ⅱ组 :0 .12 5 %布比卡因 80ml+吗啡 10mg ,Ⅲ组 :0 12 5 %布比卡因 80ml+哌替啶 10 0mg ,患者感到手术创口疼痛时自行揿压PCEA泵的自控按钮 ,每次向硬膜外腔注入镇痛药液最大限量 2ml,锁定时间 2 0min。结果　显示 48h镇痛药液累积用量Ⅰ组、Ⅲ组是Ⅱ组的 3倍 ,Ⅱ组镇痛效果达优者比Ⅲ组多。镇痛治疗期间三组患者平均动脉压、脉率和呼吸频率与麻醉前比较均无明显差异 ,脉搏血氧饱和度 (SpO2 )都保持在 95 %以上 ,Ⅱ组恶心、呕吐发生率高于其它两组 ,只有Ⅱ组出现皮肤搔痒 ;Ⅰ、Ⅱ、Ⅲ组尿潴留发生率分别为 40 % ,5 0 6 % ,40 3%。结论　用低浓度布比卡因和麻醉性镇痛药复合液行PCEA ,能获得良好的术后镇痛效果 ,对呼吸循环功能无明显影响 ,吗啡镇痛复合液镇痛效果最好 ,用量最少。

Comparison of Clinical Efficacy of Patient-controlled Epidural Analgesia in Three Narcotic Analgesics for Postoperative Pain Relief

Objective To estimatethe efficacy of patient controlled epidural analgesia in three narcotic analgesics(Morphine, Fentanyl and Pethidine)for postoperative pain Method Ninety adult patients undergoing abodominal surgical and lumbar vertebrae discectomy under epidural anesthesia were randomly divided into three groups, group Ⅰ( n =30)received PCEA with 0.125% bupivacaine+0.000125% Fentanyl, group Ⅱ( n =30)received PCEA with 0.125% bupivacaine+0.0125% Morphine, group Ⅲ( n =30)received PCEA with 0.125% bupivacaine+0.125% Pethidine All patients received epidural bolus of 5 ml solution above mentioned followed by epidural infusion at 1 ml, h 1, PCA dose (2 ml) was administered as required by the patients for supplemental analgesia with 20 minutes lockout period and total dose in 1 hour was limited at 9 ml Result The total dose of group Ⅰ and group Ⅲ were three times of group Ⅱ in first 48 h The efficacy of epidural analgesia in group Ⅱ were better than that of group Ⅲ The MAP P RR were similar to those before anesthesia Pulse oxygen saturation (SpO 2) was between 95% and 100% The incidence of nausea and vomiting in group Ⅱ was higher than that in group Ⅰ and group Ⅲ The itch of skin appeared only in group Ⅱ The incidence of retention of urine uroschesis in group Ⅰ Ⅱ and Ⅲ was 40%, 50.7% and 40.6% Conclusion PCEA ia a safe and effective analgesia method Low dose bupiracaine (0.125%) plus narcotic analgesic for PCEA may get excellent results of postoperative pain relief There are no significant changes of circulation and respiration Low dose bupivacaine (0.125%) plus 0.0125% morphine for PCEA may get the best efficacy of postoperative pain relief while least in total dose