颅脑术后背景泵注PCA的临床镇痛效果及可行性

为对比有无背景给药的病人自控镇痛(PCA)在开颅术后的镇痛效果,将120例择期全麻颅脑术后患者随机分为4组(每组30例):芬太尼组(Ⅰ组)、芬太尼背景组(Ⅱ组)、曲马多组(Ⅲ组)、曲马多背景组(Ⅳ组)。背景组于术后24 h停止背景给药,仅予单纯PCA。术后4、8 h、次日晨、24、48 h记录VAS、用药量、PCA按压次数、镇静程度及不良反应。结果:单纯PCA组的PCA按压次数、有效次数和VAS疼痛评分均明显高于背景组,而用药量明显少于背景组;2个背景组比较,芬太尼组的PCA按压次数、有效次数和用药量明显高于曲马多组,VAS疼痛评分无差异。提示:芬太尼和曲马多背景用药加PCA用于颅脑术后镇痛比单纯PCA镇痛效果更佳。

Analgesic Efficacy and Safety in Combination of Continuous Infusion and Patient-controlled Analgesia Following Craniotomy

To assess the analgesic efficacy and safty of intravenous fentanyl and tramadol by combined continuous infusion and patient-controlled analgesia (PCA) compared with those of single-PCA in the treatment of postoperative pain following craniotomy, 120 patients were randomly assigned to four groups: 1) PCA with fetanyl (1μg/mL); 2) continuous infusion of fentanyl 1mL/h (1μg/mL) supplied PCA; 3) tramadol (25 mg/mL); 4) continuous infusion of tramadol 1 mL/h (25 mg/mL) supplied PCA. Continuous infusion was stopped at 24 h after craniotomy. Patient pain intensity score (VAS score 0-10), PCA demanded and delivered times, total dose and side-effects were recorded. The total PCA delivered times, demand times and VAS score in groups receiving single-PCA were significantly more than those in groups receiving continuous infusion suppling PCA (P<0.05). When comparing two groups receiving a combined regimen of continuous infusion and PCA, we found that the total PCA delivered times, demand times and total dose in fentanyl group were significantly higher than tramadol group (P<0.05). The patients'VAS score had no significant difference between two groups. Fentanyl and tramadol are efficient and safe for pain control after craniotomy. The regimen of combination of PCA and background infusion is more efficient without increasing the incidence of opioid side effects.