吗啡和芬太尼用于妇科术后硬膜外镇痛的效果比较

目的观察吗啡、芬太尼用于妇科病人术后硬膜外镇痛（PCEA）的镇痛效果及不良反应。方法80例择期妇科手术患者，ASAI-Ⅱ级。随机分为两组，每组40例。A组选用0．004％吗啡＋0．02％甲氧氯普胺＋0．01％地塞米松＋0．1％罗比卡因；B组选用0．0003％芬太尼代替A组配方中的0．004％吗啡。均用PCA泵（200ml）行PCEA，以LCP模式（负荷剂量A组吗啡1．5mg，B组芬太尼0．05mg均稀释成5ml首次注入，持续输注剂量4ml／h＋PCA每次0．5ml）。结果（1）综合镇痛质量。A组与B组无明显差异（P〉0．05）；（2）A组尿潴留、恶心、呕吐、皮肤瘙痒、嗜睡等发生率较B组高（P〈0．01）。结论吗啡、芬太尼PCEA用于妇科术后镇痛均可取得满意的效果，但芬太尼较吗啡的不良反应明显少。

Comparison of Analgesic Effects between Morphine and Fentanyl in PCEA in Gynecological Patients

Objective To observe the analgestic and adverse effects of morphine and fentanyl in patient controlled epidural analgesia （PCEA） in gynecological patients. Methods A total of 80 ASA I and II gynecological patients were randomized into two groups. Group A received 0. 004% of morphine, 0.01% of metoclopramide, 0.01% of dexamethasone and 0.01% of ropivacine, and Group B was administered 0. 0003% .of fentanyl instead of morphine （ i. e. the other drugs were the same）. Postoperative analgesia was provided by PCA pump with LCP model （ load dosage 5ml ＋ lasting dosage 4ml/h ＋ 0.5ml per time）. Results （ 1 ） There was not any significant difference in the analgesic effects between the two groups （ P 〉 0.05 ）. （2） Complications such as urinary retention, nausea, vomiting, itch and sleeping were significntl milder in Group A than in Group B （ P 〈 0.05 ）. Conclusion Morphine and fentanyl are both satisfactory when used for PCEA in gynecological patients, but the adverse effects are much less with fentayl than with morphine.