芬太尼复合液PCIA或PCNA用于上肢骨折术后镇痛效果观察.docVIP

芬太尼复合液PCIA或PCNA用于上肢骨折术后镇痛效果观察【摘 要】 目的 观察上肢骨折手术后采用芬太尼复合液经臂丛鞘内患者自控镇痛(PCNA)的效果。方法 40例上肢骨折手术后患者随机分为两组：臂丛鞘内患者自控镇痛组（PCNA组）和静脉患者自控镇痛组（PCIA组）各20例。手术结束前20 min两组患者均予连接自控镇痛泵。PCNA组用0．125%罗哌卡因+芬太尼0．4 mg+氟哌利多5 mg复合液,总量100 ml；PCIA组用芬太尼0．8～1 mg+氟哌利多5 mg+生理盐水。结果 两组患者的一般情况、年龄、体质量、性别差异无统计学意义；PCIA组SBP、HR与术前比较高；PCNA组循环无明显变化。术后4～48 h的VAS评分PCNA组低于PCIA组。结论 芬太尼复合液经鞘内PCA用药或经静脉PCA用药，安全有效，但鞘内用药的镇痛质量优于静脉用药组。 ?【关键词】 上肢骨折；鞘内患者自控镇痛；静脉患者自控镇痛 The analgesic effect after the operation of upper-arm fracture with infused fentanyl into brachial plexus or intravenousZHANG Jing,CHEN Ming-hong,CAO Ji-hong,et al．The Sheko People′s Hospital of Nanshan Strict,Shenzhen,Guangdong Province,Shenzhen 518067,China?【Abstract】 Objective To observe the analgesic effect after the operation ofupper-arm fracture when infused fentanyl into brachial plexus or intravenous．Methods 40 patients were randomly devided into two groups with 20 patients in each group：Group PCNA：patients controlled nerveblokade analgesia which used fentanyl 0．4 mg,ropivacaine 0．125 mg and dropiridol 5 mg;Group PCIA:patients controlled intravenous analgesiawhich used fentanyl 0．8～1．0 mg and dropiridol 5 mg,patients in two groups began to use the analgesia pump 20 minutes before the end of operation．Results there isno obvious change of circulation in group PCNA，the heart rate and systole blood pressure become higher in group PCIA than preoperation and there is no obvious change of circulation in group PCNA，virsual analog scale in PCNA is lower than the one in PCIA．Conclusion fentanyl can be used safely both in PCNA andPCIA，but analgesia effect in PCNA is better than the one in PCIA． 【Key words】 Upper-arm fracture；PCIA；PCNA 骨科手术具有创伤大、应激反应强烈和术后疼痛明显等特点，因此需要良好的术后镇痛以抑制机体应激反应，稳定呼吸、循环功能，以减少术后并发症。笔者上肢骨折手术后镇痛采用芬太尼复合液经静脉患者自控镇痛（PCIA）和经臂丛鞘内患者自控镇痛(PCNA)两种方法，现将观察结果报告如下。 1 资料与方法 1．1 一般资料 选择40例要求术后镇痛的择期上肢骨折手术患者，男28例，女12例，年龄18～60岁；ASAⅠ～Ⅱ级，包括肱骨骨折27例，尺桡骨骨折13例。40例患者随机分为两组：臂丛鞘内患者自控镇痛组（PCNA组）和静脉患者自控镇痛组（PCIA组），各20例。PCNA组根据骨折部位不同先施行臂丛神经肌间沟或腋路穿刺并置管（置管是硬膜外导管），