【摘要】目的比较术后硬膜外和静脉应用芬太尼病人自控镇痛(PCA)两种方法的临床效果和安全性。方法60 例上腹部和胸部手术病人随机分为经硬膜外注射芬太尼病人自控镇痛(PCEA)组和静脉注射芬太尼病人自控镇痛(PCIA)组，每组 30 例。两组芬太尼负荷量为0.001 mg/kg，PCA 药物配方均为芬太尼0.5 mg+氟哌利多10 mg+0.9%氯化钠至100 ml，持续给药，滴速2 ml/h，单次PCA剂量0.5 ml，锁定时间 15 min。术后定时进行镇痛、镇静评分，24 h芬太尼用量，患者满意度及不良反应的观察比较。结果PCEA 组 24 h用药量、按键次数及术后视觉模拟评分(VAS)均明显高于 PCIA 组(P<0.05)。两组镇静评分均低且无显著性差异。患者对术后镇痛总体满意程度良好至优秀者均在83.3% 以上，不良反应发生率两组间无显著性差异。结论芬太尼用于术后镇痛安全有效。但芬太尼 PCIA 镇痛效果明显优于芬太尼 PCEA，且用药量少。

    【关键词】芬太尼；镇痛；静脉；硬膜外

    Comparison of patient- controlled analgesia of epidural with intravenous fentanyl

    ZHAO DazhongWANG XianchunZHANG Yunet al

    Department of Anesthesiology,the Second People 's Hospital of Shenzhen,Shenzhen518035,China

    【Abstract】ObjectiveTo compare the effecacy and safety of apatient- controlled analgesia(PCA)of epidural with intravenous fentanyl.Methods60 patients undergoing ordinary epigastrial or thoracic operation were randomly allocated to patient- controlled epidurai analgesia(PCEA)group(n=30)or patient- controlled intravenous anaigesia (PCIA)group(n=30).The PCA solution consists of fentanyl 0.5mg,droperidol 10mg and NS 86 ml,Loadingdose of fentanyl was 0.001mg/kg,and backgroud infusion 2ml/h,bolus 0.5ml,lockout time 15 min.The severity of pain,incidence of nausea and vomiting,total dosage of fentanyl used in 24h,and patient's satisfaction were assessed.ResultsThe total dosage of fentanyl administered,the times of temperarily pressing the PCA key and the postoperative pain scores were significantly lower in the PCIA group than those in the PCEA group.Between two growps,there was no significant difference in the overall satisfaction of pain relief,sedation and vomiting.ConclusionPCIA with fentanyl is better than PCEA with it for postoperative pain relief. ......