不同自控镇痛方式对下肢手术患者镇痛效果和睡眠质量的影响

目的比较常用的两种自控镇痛方式对下肢骨科手术患者镇痛效果和睡眠质量的影响。方法随机选择在全麻下择期行下肢骨科手术的病人80例,ASAⅠ～Ⅱ级,年龄18～45岁,体重于标准体重±10%范围内,分为4组,每组20例。Ⅰ组为术后病人静脉自控镇痛（PCⅠA）,分两亚组即：Ⅰ1组（盐酸曲马多＋枸橼酸芬太尼）,Ⅰ2组（盐酸曲马多＋枸橼酸芬太尼＋盐酸格拉司琼）。E组为术后硬膜外自控镇痛（PCEA）。C组为空白对照组。术后按需肌注盐酸哌替啶1 mg/kg。术后镇痛期间观察记录患者一般情况,镇痛效果和睡眠质量等项目。结果术后第一、二天,各镇痛组的VAS值明显小于对照组,差异有统计学意义,E组的术后镇痛效果明显优于Ⅰ1、Ⅰ2,VAS有显著性的差异（P〈0.05）,而Ⅰ1、Ⅰ2组间VAS无显著性差异（P〉0.05）。术后第三天,Ⅰ1、Ⅰ2组VAS值与对照组无显著性差异（P〉0.05）。而E组与对照组及Ⅰ1、Ⅰ2组VAS值有显著性差异,镇痛效果明显优于这三组。而Ⅰ1、Ⅰ2组间VAS无显著性差异。睡眠质量：用X2分割法对四组患者夜间睡眠状态进行比较,C组术后第1天的夜间睡眠状态显著差于其他三组（第1天χ2=15.69,P〈0.01）。其余各组无统计学差异（P〉0.05）。第2天,第3天各组的夜间睡眠状况均较好,无显著差异（P〉0.05）。结论对于下肢骨科手术后患者,硬膜外镇痛效果优于静脉镇痛,患者自控镇痛有利于术后睡眠质量的改善。

Effects of different analgesia model on analgesia and quality of sleep in patients after lower limb surgery

Objective To compare two commonly used methods for analgesia： PCIA（patient-controlled intravenous analgesia） and PCEA（patient-controlled epdural analgesia）,and their effects on analgesia and quality of sleep in patients after lower limb surgery.Methods 80 cases patients with elective lower limb surgery under general anesthesia were analyzed.The patients were divided into four groups,including I1 group treated with tramadol hydrochloride and fentanyl citrate,I2 group treated with tramadol hydrochloride,fentanyl citrate and granisetron hydrochloride,E group treated with PCEA after surgery and C group injected with pethidine 1 mg/kg on demand after surgery.The general situation of patients,the analgesic effect and sleep state were observed.Results At the first and second days after surgery,the VAS of the analgesia group was significantly lower than that of the control group.The analgesic effect of group E was significantly better than that of group I1 and group I2.The VAS between the Group I1 and Group I2 was no significant difference（P〉0.05）.At the third day after surgery,the VAS between the Group I1,Group I2 and the control group was not significantly different（P 〉0.05）.The VAS between the group E and the control group or group I1,group I2 were significant different,analgesic effect of group E was superior those three groups（P〈0.01）,while the VAS between group I1 and group I2 was not significantly different（P〉0.05）.The rate of four groups patients＇ sleep state were compared with X2 segmentation method.Result of which was on the first days the rate of patients with good sleep at night of group I1 after surgery was significantly lower than the other three groups（P〈0.01）.There was no significant difference among the remaining three groups（P〉0.05）.Conclusion For lower limb surgery patients,epidural analgesia is better than intravenous analgesia.