肌内患者自控镇痛方法的临床观察

目的 探讨肌内患者自控镇痛方法的实用性.方法 腰硬联合麻醉下全子宫切除术后镇痛患者225例,随机分为M、E、I三组,分别采用肌内患者自控镇痛、硬膜外患者自控镇痛及静脉患者自控镇痛方法进行术后镇痛.药液配方:枸橼酸舒芬太尼140 μg+0.9%氯化钠配成100 ml,背景剂量2 ml/h,自控给药量0.5 ml/15 min.通过观察患者在术后6 h、12 h、24 h、48 h四个时间点的疼痛程度(VAS)、按压次数,镇痛泵连接管路脱落重置或改行其他方法例数以及恶心呕吐、呼吸抑制发生情况综合探讨肌内患者自控镇痛方法的实用性.结果 E组12 h、24 h时VAS低于其他组,按压次数少于其他组(P<0.05),镇痛泵连接管路脱落重置或改行其他方法例数多于其他组(P<0.05);M组与I组各指标比较差异无统计学意义(P>0.05).结论 硬膜外自控效果最好,但管路脱出率高.肌内患者自控给药镇痛方法镇痛效果良好,操作简单、管理容易、实用性强,适用于术后镇痛.

Clinical research of patient-controlled intramuscular analgesia

Objective To investigate the practicability of patient-controlled intramuscular analgesia(PCMA).Methods 225 patients of postoperative analgesia after hysterectomy under combined spinal-epidural anesthesia were randomly assigned to three groups:group M(patient-controlled intramuscular analgesia,PCMA),group E(patient-controlled epidural analgesia,PCEA)and group I(patient-controlled intravenous analgesia,PCIA). The dispensing of analgesic medicament was as follows:sufentanyl 140 μg,0.9 % sodium chloride injection,prepare to be solution of 100 ml.To investigate the practicability of patient-controlled intramuscular analgesia by observed pain VAS score on the time points of 6,12,24 and 48 hour after operation,the cases of unexpected injection,the cases of pipe extrusion and switch to other measures,the incidence of postoperative nausea and vomiting,respiratory depression.Results On the time of 12 and 24 hours,the VAS in group E was lower than the other two groups,and the cases of unexpected injection less than the other two groups(P<0.05),but the cases of pipe extrusion significantly more than that of other two groups(P<0.05),there was no significant differences in each index in group M and group I(P>0.05).Conclusions PCEA effect is the best,but the rate of pipe extrusion is higher,PCMA shows equivalent effect,convenient operation,strong practicality,and suitable for postoperative analgesia.