芬太尼用于妇产科术后镇痛效果的临床观察
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【中图分类号】R719.3+1 【文献标识码】A【文章编号】1672-6383-(2010)12-0075-01
【摘要】目的：观察芬太尼用于妇产科术后镇痛效果。方法：200例妇产科病人，ASA分级Ⅰ～Ⅱ级，年龄22～60岁，其中子宫全切术50例；附件切除术40例；剖宫产术110例。术中采用腰硬联合麻醉，穿刺间隙为L2～L3、L3～L4，术中麻醉效果满意，手术顺利，术后将受术者采用双盲法分为两组，自控硬膜外镇痛PCEA组100例(术后保留硬膜外导管)，肌肉注射组100例，注射强痛定、哌替啶等止痛药物(术后拔除硬膜外导管)。PCEA组100ml药液中含芬太尼0.5mg、甲磺酸罗哌卡因357.6mg、枢丹8mg。负荷剂量：首次用药5ml，持续剂量2ml/h，按键锁定时间0.5ml/15min，即15min内按压启动键仅一次有效，病人可根据疼痛情况按压一次有效剂量。镇痛时间为48h，观察术后6h、12h、24h、48h两组间镇痛效果。结果：两组病人术后48h内呼吸、循环无明显变化。恶心、呕吐PCEA组低于肌肉注射组。VAS评分：PCEA组低于肌肉注射组，PCEA组镇痛效果最佳。结论：采用PCEA方法由病人参与自控镇痛，能有效的控制术后疼痛，血压、心率平稳，能较好的改善呼吸功能，可用力咳嗽，正确有效的呼吸，预防呼吸道感染，减少肺部并发症，促进刀口愈合，使病人早日康复。我院在芬太尼应用于术后镇痛取得了满意效果。
【关键词】芬太尼；术后阵痛；PCEA
Fentanyl for postoperative analgesia in gynecology and obstetrics clinical observation
Guo Liang
【Abstract】Objective：To observe the analgesic effect of fentanyl for obstetrics and gynecology. Methods： 200 cases of obstetric and gynecological patients， ASA grade Ⅰ - Ⅱ， aged 22～60 years， of which 50 cases of hysterectomy； Annex 40 cases of resection； 110 cases of cesarean section. Intraoperative use of epidural anesthesia， puncture gap L2～L3， L3～L4， anesthetic effects of satisfaction， the successful operation and postoperative patients who will be divided into two groups by double-blind， controlled epidural analgesia PCEA 100 patients (epidural catheter after reservation)， intramuscular injection of 100 patients， injection of strong pain setting， pethidine and other analgesics (after removal of epidural catheter). 100ml liquid in the PCEA group with fentanyl 0.5mg， ropivacaine mesylate 357.6mg， Ondansetron 8mg. Loading dose： the first drug 5ml， continuous dose of 2ml / h， keypad lock time 0.5ml/15min， press the start button is 15min， one time only， the patient can press an effective dose of pain conditions. Analgesia time was 48h， observed after 6h， 12h， 24h， 48h analgesic effect between the two groups. Two groups of patients within 48h after the results of respiratory， circulatory no significant change. Nausea， vomiting PCEA group than in intramuscular group. VAS score： PCEA group was lower than intramuscular injection group， PCEA group the best analgesic effect. Conclusion PCEA participation by the patient-controlled analgesia method can effectively control postoperative pain， blood pressure， heart rate stable， can be better to improve the respiratory function， coughing hard， correct and effective breathing ......
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