胫腓骨手术后静脉自控镇痛两种追加负荷剂量方法的效果比较

目的观察胫腓骨手术后静脉自控镇痛两种追加负荷剂量方法的效果。方法将120例低位硬膜外麻醉胫腓骨手术患者按随机数字表分为两组，A组60例，硬膜外麻醉给药4h后，每隔10～15min按压自控镇痛笔1次，连续311；13组60例，术毕即刻遵医嘱给予镇痛负荷剂量舒芬太尼0．1μg／kg，当疼痛视觉模拟评分静息状态≥4分或活动状态≥6分，按压自控镇痛笔1次。比较两组患者术后上泵即刻、30rain、1h、2h、3h、6h、12h、24h、36h、48h静息及活动状态的镇痛评分、镇静评分及不良反应。结果A组术后3h、6h、12h静息及活动状态疼痛视觉模拟评分均低于B组，P〈0．05；镇痛不全A组5例、B组23例；两组患者镇静评分及不良反应发生率比较无统计学意义（P〉0．05）。结论单次硬膜外麻醉胫腓骨手术后静脉自控镇痛宜选定时定量持续给药。

Comparison on effect of two ways of adding loading dose in patient-controlled intravenous analgesia after tibia and fibula operation

Objective To observe the effect of two ways of adding loading dose in patient--controlled intravenous anal- gesia after tibia and fibula operation. Method Divide 120 patients undergoing tibia and fibula operation by lower epidural anesthesia into Group A and B according to random number table. 60 patients in Group A press patient--controlled analgesia pen every 10--15 minutes for 3 hours after 4 hours＇ epidural anesthesia. 60 patients in Group B receive loading dose of sufentanil 0. 1 ptg/kg after operation according to medical order and press patient--controlled analgesia pen when their pain visual analogue scale≥4 in resting or ≥6 in motion. Compare the analgesia scores of resting and motion, sedation score and adverse reaction of two groups at present, 30rain, lh, 2h, 3h, 6h, 12h, 36h and 48h after operation. Result VAS scores of resting and motion 3h, 6h and 12h after operation in Group A are lower than in Group B （P〈0. 05）. There are 5 cases of incomplete analgesia in Group A and 23 cases in Group i3. There is no significant difference on sedation score and rate of adverse reaction between two groups （P〉0. 05）. Conclusion Patient--controlled intravenous analgesia after tibia and fibula operation by single epidural anesthesia should use continuous administration at a regular time and a certain dosage.