静脉自控镇痛联合美蓝注射用于肛肠病患者术后的镇痛效果观察

目的:探讨肛肠疾病患者术后静脉自控镇痛(PCIA)联合美蓝注射的效果和不良反应。方法:选择肛肠病患者手术90例(ASAⅠ~Ⅱ),随机分为2组(A组、B组),每组30例。其中,A组为联合镇痛组,手术结束时局部PCIA加美蓝注射;B为单纯PCIA组。采用视觉模拟评分(VAS)和患者舒适状态评分(BCS)观察记录两组术后4 h、8 h、24 h、48 h、60 h疼痛强度和舒适状态,并观察60 h内不良反应的发生率。结果:术后4 h、8 h、24 h、48 h两组患者VAS评分比较无统计学意义(P>0.05),但是术后60 h镇痛泵撤除后两组患者VAS评分A组低于B组(P<0.05);术后4 h、8 h、24 h、48 h两组患者BCS评分比较无统计学意义(P>0.05),但术后60 h两组患者BCS评分A组高于B组(P<0.05);两组患者术后恶心呕吐、尿潴留、上消化道出血发生率比较无统计学意义(P>0.05),但B组头晕发生率较A组高(P<0.05)。结论:PCIA联合美蓝注射的镇痛模式用于肛肠手术患者在保证镇痛效果的同时,降低了不良反应发生率,延长了镇痛时间,更为有效的减轻患者的痛苦,患者更为舒适。

Research on Postoperative Analgesic Effect of PCIA Combined with Injection of Methylene Blue for Anorectal Patients

Objective： To study the analgesic effect and adverse reaction of PCIA （Patient controlled intravenous analgesia） combined administration of Methylthioninium Chloride for postoperative anorectal patients. Methods： 90 postoperative anorectal patients （ASA I - II ） were randomly divided into 2 groups （group A, B）, 30 cases in each group. The patients in group A were given combined injection of Methylthioninium Chloride and PCIA after operation. The patients in group B were simply treated with PCIA. By using the visual analogue scale （VAS） and Bruggrmann comfort scale （ BCS）, the pain intensity and incidence of adverse reactions were observed in the two groups respectively in 4 h, 8 h, 24 h, 48 h, 60 h after operation. Result： The results assessed by VAS in both groups in 4 h, 8 h, 24 h, 48 h after operation showed there was no significant statistical difference （P 〉 0.05 ）. However, the results of VAS in group A were lower than those in group B （ P 〈 0.05 ） in 60h after operation when the analgesic pumps were removed ; results evaluated by BCS in both groups in 4 h, 8 h, 24 h, 48 h after operation showed there were no significant statistical difference （ P 〉 0. 05 ）, but BCS in group A were higher than those in group B （ P 〉 0.05 ） 60 h after operation. The comparison of the incidence of nausea and vomiting; urinary retention, upper digestive tract hemorrhage after operation in two groups showed there was no statistical difference （ P 〉 0.05 ）, but higher incidence of dizziness in group B compared with group A was observed （P 〈 0.05 ）. Conclusion： PCIA combined with administration of Methylthioninium Chloride is better than simple treatment with PCIA for postoperative anorectal patients. The former assures the effect of analgesia, reduces the incidence of adverse reactions and extends the analgesia time. In a word, it relieves the pain of anorectal patients more effectively.