舒芬太尼静脉与皮下患者自控镇痛用于脊柱手术后镇痛疗效的比较

目的评价经静脉与皮下舒芬太尼患者自控镇痛的疗效果及安全性。方法将100例拟行腰椎内固定手术患者随机分为静脉自控镇痛组（PCIA组）和皮下自控镇痛组（PCSA组）,每组各50例。镇痛液配方均为舒芬太尼1μg/ml（含氟哌利多2.5mg/50ml）。术毕患者清醒后接镇痛泵,采用持续输注＋PCA（CP）镇痛模式。比较两组术后8、24和48h静息与活动视觉模拟（VAS）评分、舒芬太尼用量和平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）,并比较两组的整体镇痛满意度及不良反应情况。结果两组间术后不同时间点静息与活动VAS评分、舒芬太尼用量及MAP、HR、SpO2值比较均无统计学差异（P〉0.05）。两组术后恶心呕吐、嗜睡、呼吸抑制和皮肤瘙痒的发生率比较无统计学差异（P〉0.05）,但PCSA组的镇痛满意度评分更高（P〈0.05）。结论舒芬太尼PCIA与PCSA的疗效和不良反应无统计学差异,均可安全地用于脊柱手术患者的术后镇痛,但PCSA更方便简单,患者镇痛满意度评分更高,值得推广应用。

A comparison of postoperative pain relief of sulfentanil PCIA with PCSA in patients after spinal surgery

Objective To compare the pain relief efficacy and safety of sulfentanil intravenous PCA （PCIA） and subcutaneous PCA （PCSA） in the patients under. Methods 100 patients （ASA I~II） were divided randomly into two groups after surgery： Group PCIA （n=50） and Group PCSA （n=50）. Sulfentanil 1μg/ml （with Droperidol 50μg/ml） was given in both groups. The following variables including visual analog score （VAS） at rest or movement, consumption of sulfentanil, mean blood pressure （MAP）, heart rate （HR）, pulse oxygenation saturation （SpO2） were recorded at time intervals of 8,24,48 hours after operation. Patient satisfaction and adverse reaction were also recorded. Results There was no significant difference between Group PCIA and Group PCSA in the VAS at rest and movement, consumption of sulfentanil, MAP, HR and SpO2（P0.05）. No differences existed in the incidence of nausea and vomiting,drowsiness between those two groups（P0.05）. However, patient satisfaction score was higher in the group PCSA （P0.05）. Conclusion Both of the PCIA and PCSA were sufficient and safe for postoperative analgesia for patients after spinal surgery, without difference in efficiency and incidence of adverse events. It was suggested that PCSA is better with its convenience and higher patient satisfaction.