芬太尼静脉与皮下病人自控镇痛用于 心脏手术后镇痛疗效.pdf

中国疼痛医学杂志ChineseJournalofPainMedicine2001,7,(1)·11·

芬太尼静脉与皮下病人自控镇痛用于
心脏手术后镇痛疗效的随机对照研究

黄维勤1安建雄2许建屏2罗非3陈雷2刘进2
(1北华大学医学院附属医院麻醉科,吉林132011;2中国医学科学院中国协和医科大学阜外心血管病医院,
3北京医科大学神经科学研究所)

摘要目的:对经静脉与皮下芬太尼病人自控镇痛的疗效、安全性及实用性进行评价。方
法:将64例ASAⅠ～Ⅱ级心脏手术后病人随机分为病人自控静脉镇痛(PCIA)与病人自控
皮下镇痛(PCSA)组,其中PCIA组31例,PCSA组33例。药物为每毫升含芬太尼25μg和
利多卡因10mg的混合液。PCA设置:负荷量2ml;单次剂量1ml;背景剂量0.1ml/h;小时
限量8ml/h;锁定时间3min。入选本研究的适应证是拔除气管导管后8h内安静或咳嗽时疼
痛视觉模拟评分在3分以上,且无PCA禁忌证者。于负荷量注射完毕后记录镇痛起效时
间,并于拔除气管导管后24,48,72h记录各项指标。结果:两组病人的一般情况及各项生命
体征之间无显著性差异(P>0.05),两组间芬太尼用量、镇痛满意度及副作用无显著性差
异。PCSA组镇痛起效时间显著长于PCIA组(P<0.01),PCSA组PCA报警次数百分率显
著低于PCIA组(P<0.01)。结论:芬太尼PCIA与PCSA的疗效和副作用无显著性差异,
但PCSA更方便简单,PCSA的报警次数显著少于静脉组。
关键词芬太尼;病人自控镇痛;静脉;皮下

RANDOMIZEDCONTROLLEDSTUDYOFPOSTOPERATIVEPAINRELIEFEFFECT
OFINTRAVENOUSPCAANDSUBCUTANEOUSPCAFENTANYLAFTERCARDIAC
SURGERY
HUANGWei2Qin,ANJian2Xiong,XUJian2Ping,LUOFei,CHENLei,LIUJin
DepartmentofAnesthesiology,CardiovascularInstituteandFuwaiHospital,ChineseAcademy
ofMedicalSciences&BeijingUnionMedicalCollege,Beijing100037
AbstractObjective:Tocomparethepainreliefefficacy,safetyandprognosisofintravenous
PCA(PCIA)andsubcutaneousPCA(PCSA).Methods:Sixty2fourpatients(preoperativecar2
diacfunctionofASAI2II)weredividedrandomlyintotowgroupsaftercardiacsurgery:Group
PCIA(n=31)andGroupPCSA(n=33).Themixtureoffentanyl(25μg/ml)andlidocaine
(10mg/ml)wasgiveninbothgroups.PCAsetting:Loadingdoseof2ml,bolusdoseof1ml,
backgroundinfusionof0.1ml/h,hourlimitof8ml/h,andlockouttimeof3minuteswasset.
Patientswithpainscoreabove3onVisualAnalogScale8hafterextubationandwithoutany
contraindicationsofPCAwereenrolledinthisstudy.Thefollowingvariableswererecordedat
timeintervalsof24,48,and72hoursafterextubation.Result:Therewassignificantdiffer2
encebetweenGroupPCIAandGroupPCSAinonsetofanalgesia(P<0.01).Equipment
breakdowninGroupPCSAwasmarkedlylowerthanthatinGroupPCIA(P<0.01).There
werenodifferencesinsexualdistribution,stateofdrink,levelofeducation,analgesiaefficacy,
incidenceofnauseaandvomiting,patientsatisfaction,recoveringtimeofgutmotility