【摘要】 目的 观察硬膜外吗啡预先镇痛对术后硬膜外病人自控镇痛(PCEA)效果的影响。方法 选择ASA Ⅰ～Ⅱ级、择期在硬膜外麻醉下经腹子宫切除术病人40例,随机分为预先镇痛组(A组)和术后镇痛组(B组),每组20例。硬膜外阻滞所用局麻药均为2％利多卡因。采用负荷量+持续量+PCA量(LCP)模式病人自控镇痛:负荷量3 ml(2mg吗啡+1.25ng氟哌啶)+持续输注量100 ml(0.125％布比卡因100ml中含3mg吗啡及2.5mg氟哌啶)+PCA量,镇痛泵流速2ml/h,单次PCA量2ml,锁定时间为15 min。A组在切皮前20min经硬膜外导管注入负荷量作为预痛,B组则在术毕注入负荷量。观察并记录术后4、8、12、24、48 h的视觉模拟疼痛评分(VAS)、Ramesay镇静评分、PCA总需要量、总体满意度及并发症情况。结果 A组在术后8、12、24、48 h的VAS评分均显著小于B组(P<0.05);Ramesay镇静评分及总体满意度则显著高于B组(P<0.05),但A组的PCA总需要量却明显少于B组(P<0.05)。两组均无呼吸抑制发生,且恶心、呕吐及皮肤瘙痒的发生率组间差异不显著。结论 硬膜外吗啡预先镇痛效果优于术后镇痛,且并发症不增加。更多还原

【Abstract】 Objective To observe the epidrral morphine preemptive analgesia effect on patient-controlled epidural analgesia (PCEA) in patients after surgery. Methods 40 ASA physical status I-Ⅱpatients undergoing elective abdominal hysterectomy under epidural block were randomly assigned to two groups preemptive analgeia group (group A, n = 20) and postoperative analgesia group (group B, n=20). 2%lidocaine was used for anesthesic induction and maintenance. The PCEA pump was used after the operation (LCP model load+continous infusion +PCA),load dose of 3 ml containing morphine 2 mg and droperidol 1.25 mg, continuous infusion volume of 2 ml / h(morphine 3mg and droperidol 2.5 mg in 0.125% bupivacaine 100ml), single PCA dose of 2ml and lock out time of 15min were set. Load dose was injected epidurally in group A at 20 min before incision as preemptive analgesia, and in group B after the operation. Visual analogue scale (VAS) and ramesay sedation scale of 4,8,12,24,48h after the operation were recorded. Total PCA volume and total satisfaction were recorded and complications were observed too. Results VAS at 8,12,24,48h after the operation in group A were lower than that in group B(P < 0.05);Ramesay sedation scale and total satisfaction in group A were markedly higher than those in group B(P < 0.05),but total PCA volume of guoup A was less than that of group B(P < 0.05).No respiratory inhibition was found in two groups. There was no obvious difference in two groups on incidence of nausea and vomiting and skin pruritus. Conclusion preemptive epidural morphine has a better analgesic effect than postoperative pain relief technique with no increase in the complications.更多还原