骨科护理论文与骨外科护理论文：骨科病人术后采用2种不同途径自控镇痛的效果观察及护理.docVIP

骨科护理论文与骨外科护理论文：骨科病人术后采用2种不同途径自控镇痛的效果观察及护理 摘　要:目的　探讨硬膜外自控镇痛(PCEA)及静脉自控镇痛(PCIA)2种镇痛方式在骨科术后应用的效果、不良反应及护理特点。方法　将280例硬膜外麻醉术后的骨科病人随机分为2组,分别予PCEA及PCIA镇痛治疗。结果　①视觉模拟评分(VAS)评估镇痛效果:术毕,术后6h、12h、24h及48h VAS评分,2组间差异无显著性(P0·05)。②不良反应:PCEA组不良反应的发生率高于PCIA组(P0·05)。结论　PCEA和PCIA用于骨科术后病人均可获得满意的镇痛效果,护理上各有其特点,临床工作中应分别对待。 关键词:自控镇痛;骨科手术;不良反应;护理 Effect Observation and Nursing on Two way of Patient-controlled Analgesia Used on Postoperative Patients withSkeletal Disease Abstract:Objective　To explore the clinical effect,side-effect and nursing features of Patient-controlled EpiduraAnalgesia (PCEA) and Patient-controlled Intravenous Analgesia(PCIA) used on postoperative patients with skeletaldisease·Methods　Divided 280 postoperative patients with skeletal disease into two groups randomly,and eased theirpain respectively with PCEA and PCIA·Results　①Visual Analog Scale(VAS) for evaluating effect:there was no sig-nificant difference between two groups during 48 hours patient-controlled analgesia(P0·05)·②Occurring rate ofside-effect of PCEA group was higher than that of PCIA group(P0·05)·Conclusion　The effects of PCEA andPCIA are satisfied when they are used on postoperative patients with skeletal disease·PCEA and PCIA have their ownnursing feature and should be dealt with respectively· Key words:Patient-controlled analgesia; Skeletal operation; Side-effect; Nursing　　 手术后病人自控镇痛(Patient-controlled Anal-gesia,PCA)自90年代进入我国以来,已在临床广泛应用。我院从1996年开始使用该技术,骨科手术病人应用率达92%。目前主要有2种方式,即硬膜外PCA(Patient-controlled Epidura Analgesia,PCEA)及静脉PCA(Patient-controlled Intravenous Analgesia,PCIA)。我科采用了上述2种PCA技术在骨科术后病人中应用,并观察临床疗效及不良反应,对其护理特点进行分析,现报告如下: 1　资料与方法 1·1　一般资料　选择　280例麻醉方式为硬膜外麻的骨科手术病人,手术种类包括下肢骨折、脊柱骨折、骨盆骨折、腰椎间盘摘除术等。将病人随机分为PCEA组(142例)和PCIA组(138例)。其中PCEA组男103例,女39例,年龄21~50岁,体重42~70kg;PCIA组男95例,女43例,年龄23~49岁,体重41~ 63kg。2组病人在性别比例、年龄及体重等方面均无统计学差异(P0·05)。 1·2　镇痛方法 1·2·1　PCEA组　采用英国Graseby-9300便携式PCA泵,泵内药物为0·125%布比卡因+芬太尼2μg/ml+氟哌啶50μg/ml(参数设定:负荷剂量4ml,持续剂量2ml/h,PCA剂量2ml,锁定时间30min)。于术后连接,持续镇痛48h[1]。 1·2·2　PCIA组　PCA泵同前,泵内药物为芬