【摘要】 目的比较术后皮下芬太尼与硬膜外吗啡自控镇痛的效果、安全性及实用性。方法60例ASA Ⅰ～Ⅱ级择期行腹部手术患者随机分为两组,每组30例。Ⅰ组采用芬太尼皮下自控镇痛(PCSA),配方为芬太尼2 mg+氟哌利多5 mg,用0.9％生理盐水稀释至100 ml,设置背景剂量芬太尼6～8 μg/(Kg·h),PCA4μg/(kg·h),锁定时间10min,术毕在前上臂内侧近腋窝处皮下埋置7号头皮针固定后接PCA装置。Ⅱ组为硬膜外吗啡自控镇痛(PCEA),配方为吗啡10 mg+0.25％布比卡因125 mg+氟哌利多5 mg,用0.9％生理盐水稀释至100 ml。设置背景剂量2ml/h,PCA2ml,锁定时间20 min,术毕接PCA装置。结果 Ⅰ组患者按压给药键次数多于Ⅱ组(P<0.05)。镇静程度好于Ⅱ组(P<0.05)。无皮肤瘙痒。肠蠕动恢复时间较短(P<0.05),但恶心、呕吐高于Ⅱ组(P<0.05)。结论PCSA与PCEA均能起到安全而满意的镇痛效果,但Ⅰ组操作简便,护理方便,对胃肠功能影响小。更多还原

【Abstract】 Objective To evaluate the effect,safety and practicability of postoperative analgesia by epidural morphine or subcutaneous fentanyl. Methods 60 patients undertaking selective abdomen operations were divided randomly into group Ⅰ (PCSA, n = 30) and group Ⅱ (PCEA, n = 30). Group Ⅰ: subcutaneous 0.9% NS 100 ml containing fentanyl 2mg and droperidol 5 mg was administered continuously (back ground dose of fentanyl 6~8 μg/(kg.h) ,PCA 4 μg/(kg.h), lockout time 10 minutes.);Group Ⅱ :epidural 0.9% NS 100 ml containing morphine 10mg and droperidol 5mg and bupi-caine 100 mg was administered continuously (back ground dose 2 ml/h, PCA 2 ml/time, lockout time 20 minutes)Results The incidence of nausea and vomiting in group Ⅰ was higher than that in group Ⅱ (P<0.05). The degree of sedation in group I was stonger than that in group Ⅱ (P<0.05). The number of time that patients pressed key in the early period in group Ⅰ was more than that in group Ⅱ. (P<0.05). Conclusion The satisfying and safe effect of postoperative analgesia can be obtained by both epidural morphine and subcutaneous fentanyl. PCA by subcutaneous fentanyl was more convenient,less negative gastrointestinal effect,and more easily popularized.更多还原