三种镇痛方法用于骨科下肢手术患者术后镇痛的比较

目的比较3种不同术后镇痛方法用于骨科下肢手术的镇痛效果及不良反应。方法90例择期下肢骨科手术患者，在腰麻-硬膜外联合麻醉下完成手术后随机分为3组，每组30例：Ⅰ组为静脉自控镇痛；Ⅱ组为硬膜外单次注射小剂量吗啡；Ⅲ组为硬膜外单次注射小剂量吗啡与静脉自控镇痛相结合，观察术后镇痛效果、镇静评分与不良反应。结果Ⅲ组术后VAS评分较Ⅰ、Ⅱ组平稳，Ⅲ组PCA按压次数与用药剂量均少于Ⅰ组。Ⅱ组镇静较Ⅰ、Ⅲ组浅，其术后恶心呕吐发生率高于Ⅰ、Ⅲ组。结论下肢骨科手术硬膜外单次小剂量吗啡结合静脉自控镇痛的术后镇痛效果优于单纯静脉自控镇痛及硬膜外单次注射小剂量吗啡，不良反应少。

Comparism of different PCA methods in lower limb orthopedic patients

Objective To compare the effects of patient-controlled analgesia （PCA） with different methods in patients after lower limb orthopedic operations. Methods Ninety patients after lower limb orthopedic operations were randomly divided into three groups with 30 cases in each. Patient-controlled intravenous analgesia （PCIA） were administered in group I , epidural analgesia with small dose of morphine in group Ⅱ, and epidural analgesia combined with PCIA in group Ⅱ. Visual analogue scales（VAS）, sedation score and adverse effects were observed postoperatively. Results VAS was lower in group Ⅲ than that in group Ⅰ and group Ⅱ. Sedation score in group Ⅱ was lower than that in group Ⅰ and group Ⅲ. Fewer adverse effects such as nausea and vomiting were caused in group Ⅲ than that in group Ⅰ and group Ⅱ. Conclusion Combined small dose of morphine epidural analgesia with PCIA can provide a good and safe postoperative analgesia in lower limb orthopedic surgical patients.