硬膜外吗啡超前镇痛联合静脉自控镇痛在下肢骨科手术的应用

 目的 观察硬膜外吗啡超前镇痛与静脉自控镇痛联合用于下肢手术的镇痛效果及不良反应.方法 择期行下肢骨科手术患者40例,随机分为静脉自控镇痛组(Ⅰ组)和硬膜外吗啡超前镇痛与静脉自控镇痛联合组(Ⅱ组).统计两组术后4、12、24、48 h各时间点的视觉模拟评分(VAS)、镇静评分及镇痛满意率,并记录按PCA键总次数(D1)、有效按压次数(D2),以及术后不良反应.结果 术后4、12、24hⅡ组VAS明显低于Ⅰ组(P＜0.05)；术后4、12、24、48 h两组的镇静评分无统计学差异(P＞0.05)；镇痛满意率Ⅱ组(95％)大于Ⅰ组(70％,P ＜0.05)；D1/D2Ⅱ组小于Ⅰ组,差异有统计学意义(P＜0.05).结论 硬膜外吗啡超前镇痛与静脉自控镇痛联合用于下肢手术镇痛效果更为理想.

Preemptive analgesia using epidural morphine combined with controlled intravenous anal gesia for patients after the operation of lower extremities

Objective To study the effect and adverse reactions of preemptive analgesia using epidural morphine combined with controlled intravenous analgesia on patients after the operation of lower extremities.Methods Forty patients who had received an operation of lower extremities were randomly divided into 2 groups:groupⅠ（controlled intravenous analgesia） and groupⅡ（preemptive analgesia with epidural morphine combined with controlled intravenous analgesia）.The visual analogue scale（VAS）,sedation score,rate of satisfaction with analgesia,total pressing times of the PCA button（D1）,effective pressing times of the PCA button（D2 ） and side reactions such as nausea,vomiting and pruritus were observed and recorded.Results Visual analogue scales（VAS） of patients at four,twelve and twenty - four hours after operation in groupⅡwas significantly lower than those in groupⅠ（P<0.05 ）. There was no statistically significant difference in the sedation score between groupⅠand groupⅡ（P>0.05 ）.The rate of satisfaction with analgesia in patients of groupⅡwas significantly higher than that in groupⅠ（P<0.05 ）.D₁/ D₂ in patients of groupⅡwas significantly lower than that in groupⅠ（P<0.05）.There were no statistically significant difference in the incidence of side reactions between groupⅠand groupⅡ（P>0.05 ）.Conclusions The preemptive analgesia using epidural morphine combined with controlled intravenous analgesia for the patients after the operation of lower extremities has better analgesic effect.