前列腺切除术后静脉自控镇痛与连续硬脊膜外腔镇痛治疗的疗效观察

目的：探讨静脉吗啡自控镇痛（PCIA）与连续硬脊膜外腔吗啡镇痛（CEIA）对前列腺切除术后镇痛效果和安全性。方法：60例前列腺切除术后患者随机分成PCIA组、CEIA组及对照组各20例。CEIA组持续性经硬脊膜外腔导管注入吗啡0．08mg/h；PICA组在术后经静脉持续给吗啡2．0mg/h，患者疼痛时自行追加吗啡1．0mg/次，锁定时间20min；对照组出现时疼痛时肌肉注射度冷丁50mg或其他解痉镇痛药。采用视觉模拟评分（VAS）法观察各组测道评分，记录各组患者膀胱痉挛次数及持续时间、停止冲洗时间等。结果：PCIA与CEIA两组与对照组相比具有镇痛效果显著、膀胱痉挛次数少、疼痛持续时间短的优点（P＜0．001）；PCIA与CEIA两组相比上述指标差异无显著性意义，但剂量及不良反应的差异有显著性意义（P＜0．05）；术后康复指标各组间差异无显著性意义。结论：吗啡PCIA及CEIA给药对前列腺切除术后患者镇痛效果良好，但对因血凝块引起的膀胱痉挛性疼痛均无效。从镇痛效果及不良反应等综合因素评估以CEIA为优。

Application of morphine analgesia at varied channel for the treatment after prostatectomy

Purpose:To evaluate the analgesic effects of patient-controlled intravenous morphine and continuous infusion of morphine into epidural space in postoperative pain relief.Methods:Sixty patients undergoing prostatectomy under epidural anesthesia were randomly assigned to epidural morphine group-background infusion(CEIA) or patient-controlled intravenous analgesia(PCIA) group and control group. CEIA group, 0.08 mg/h of morphine was injected into epidural space. In PCIA group, 2.0 mg/h of morphine as a recommended dose would be injected intravenously by the patient through a patient-controlled analgesic delivery system in which another 1 mg morphine can be injected whenever patient feel pain until the pain relieved. The lockout time of 20 mins. VAS, frequency and duration of bladder spasm for discontinuance of bladder instillation were observed in various groups. Results:PCIA and CEIA is superior to the control group with characteristics of stable analgesic effect,short duration and low frequency of bladder spasna, (P< 0.001). There was no significant difference between the PCIA group and CEIA group (P> 0.05). But dose and unusual adverse reactions was significant (P< 0.05). No significant differences can be found in the index for postoperative recovery in each group (P> 0.05). Conclusion:The analgesia effects of morphine PCIA and CEIA are very well but they are invalid with the pain caused by bladder spasm, which are triggered by the obstruction of clot, conclusively, CEIA is better.