术后芬太尼皮下镇痛及对胃肠功能影响的研究

【】　目的　比较术后芬太尼皮下镇痛（PCSA）与硬膜外镇痛（PCEA）的临床效果，以及对胃肠功能的影响。　方法　2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例，术后分别实施PCSA与PCEA，观察术后第4、8、12、24、48h的镇痛、镇静情况，呼吸循环、恶心呕吐及其他不良事件，记录术后首次肛门排气时间，测评术后镇痛满意度。　结果　术后两组患者镇痛优良率均在90%以上，各时点镇痛评分、镇静评分、恶心呕吐发生率、首次肛门排气时间以及患者镇痛优良率差异均无统计学意义（P>0.05）。　结论　术后芬太尼PCSA与PCEA一样，效果确切，对术后胃肠功能无明显影响，患者满意，是一种安全、有效的镇痛方法。？【Abstract】　Objective　Tocompareclinicalefficiencyandgastrointestinalreactionofsubcutaneouspatient-controlledanalgesia(PCSA)andepiduralpatient-controlledanalgesia(PCEA)withfentanylanalgesicforpatientsafteroperation.　Methods　Atotalof120patientshavingundergonetransabdominalhysterectomyunderepiduralanesthesiabetweenJanuaryandJune2009acceptedPCSAorPCEAafteroperation.Weevaluatedthestateofanalgesiaandsedationatthe4th,8th,12th,24thand48thhourafteroperation.Wealsolookedintotherespiration,bloodcirculation,nausea,vomitingandotherabnormaleventsofthepatientsduringthefirst48hoursafteroperation.Atthesametime,werecordedthefirsttimeofanalexsufflationafteroperationandthedegreeofpatients’satisfaction.　Results　Theanalgesiceffectiveratewashigherthan90%inbothgroups.Therewerenosignificantdifferencesinanalgesiaandsedationscoresatabove-mentionedpointsafteroperation,incidenceofnauseaandvomiting,firsttimeofanalexsufflationoranalgesiceffectiveratebetweenthetwogroups.　Conclusion　PCSAwithfentanylcanbeaseffectiveinrelievingpostoperativepainasPCEAwithfentanylwithoutobviousadverseeffectinthegastrointestinalfunction.Therefore,PCSAisasafeandeffectivemethodtoalleviatepostoperativepain.