子宫切除术后皮下与硬膜外自控镇痛的临床效应

目的：比较子宫全切术后芬太尼用于病人自控皮下镇痛与硬膜外镇痛的临床效应。方法：选择全麻下子宫全切术病人60例,术后病人行自控皮下镇痛（PCSA）和硬膜外镇痛（PCEA）,并根据不同的镇痛方法随机分为两组：皮下镇痛组（S组）和硬膜外镇痛（E组）,每组30例。S组配方为芬太尼1mg＋利多卡因150mg,E组为芬太尼0.5mg＋布比卡因150mg,两组均加生理盐水稀释到100ml。术后48h内采用视觉模拟评分（VAS）、PCA按压次数、镇痛满意度评分来观察各组镇痛效应,并记录恶心、呕吐、皮肤瘙痒等不良反应的发生率。结果：两组病人术后48h内的视觉模拟评分（VAS）、PCA按压次数、镇痛满意度以及不良反应发生率等的比较,差异无统计学意义（P〉0.05）,而E组恶心呕吐、尿潴留和局部反应的发生率显著高于S组（P〈0.05）。镇痛期间无呼吸抑制等严重并发症的发生。结论：病人自控皮下镇痛与硬膜外镇痛用于子宫全切术后均可取得满意的镇痛效果,而皮下镇痛实际应用时更为方便且不良反应少。

Clinical effect of subcutaneous and epidural patient-controlled analgesia in total hysterectomy patients

Objective:To compare the analgesic efficacy and complications of epidural and subcutaneous patient-controlled analgesia(PCA)of fentanyl mixed with local anesthetics in postoperative total hysterectomy patients. Methods:60 patients undergoing total hysterectomy in general anesthesia were randomly divided into two groups with thirty cases in each: subcutaneous analgesia group (S) and epidural analgesia group (E).The mixture of fentanyl 1 mg and lidocaine 150 mg was administered in group S,while the mixture of fentanyl 0.5 mg and bupivacaine 150 mg was used in group E. The visual analog scale(VAS),times of PCA, patient's satisfaction and incidence of side effects were recorded during the period of postoperative 48 hours.Results:There were no significant differences in the VAS scores, demanded delivery and patient satisfaction(P>0.05).The incidence of gastrointestinal reaction, urine retention and local reaction in group E were significantly higher than that of group S(P<0.05). There was no respiratory depression occurring in two groups. Conclusion:Subcutaneous and epidural patient controlled analgesia can be used to relieve postoperative pain in total hysterectomy patients , but the method of subcutaneous analgesia is more convinient to patients and can be an alternative for that of epidural one.