术后镇痛10年后质量控制探析：1168例回顾性探究.docVIP

术后镇痛10年后质量控制探析：1168例回顾性探究 　 作者：莫利求，黄文起，孙来保，肖亮灿，谭洁芳，陈秉学 【摘要】 目的 了解术后镇痛的现状，探讨术后镇痛的质量控制问题。方法 回顾近3个月1168例术后镇痛所采用的镇痛方法和预防术后恶心呕吐的方法，了解镇痛效果和副作用的发生情况，并分析影响镇痛效果和副作用发生率的有关因素，患者的满意度情况。结果 90%采用了连续硬膜外镇痛法，配方主要是小剂量吗啡复合低浓度布比卡因或罗比卡因，静脉镇痛主要采用吗啡复合氯诺昔康。预防术后恶心呕吐（PONV）的方法有5-HT3受体拮抗剂（昂丹司琼或阿扎司琼），氟哌啶，地塞米松等，单用或复合应用。连续硬膜外镇痛需要补救镇痛者约5%，静脉镇痛补救镇痛者约10%。PONV总体发生率低，妇科开腹手术低至20%，女性非妇科手术低至10%，剖宫产术低至1%，使用氟哌啶使妇科手术PONV降低约50%。1例高龄患者出现血氧饱和度下降至82%，经停药、吸氧等处理好转。硬膜外导管脱落0.5%。瘙痒、头晕等并发症小于5%。通过补救镇痛，及时处理并发症，患者满意度在90%以上。结论 硬膜外镇痛方法效果优于静脉镇痛方法，适度镇痛，减少镇痛药量，增加安全性，重视PONV的预防，及时处理镇痛不足和副作用，从而提高患者的满意度，是术后镇痛质量控制的可行的理念和方法。 【关键词】 术后镇痛；术后恶心呕吐；质量控制 【Abstract】 Objective To investigate the current status of postoperative analgesia，to explore the quality control of postoperative analgesia.Methods Retrospective study of 1168 cases of postoperative analgesia，the methods of the analgesia and the methods of prevention of postoperative nausea and vomiting(PONV) were recorded，the effects of analgesia and related complication were recorded. Factors that affect the effects of analgesia and complication were analyzed. Satisfaction of the patients was recorded.Results 90% of the methods of analgesia were continuous epidural analgesia(CEA) with low dose of morphine combined with low concentration of bupivacaine or ropivacaine. The most common ways of continuous intravenous postoperative analgesia (CIA)was the combination of morphine and lornoxicam. The 5-HT3 antagonist (Ondansetron or Azasetron)，droperidol，dexamethasone were used singly or in combination for the prevention of PONV.Rescue analgesia was required in only 5% of CEA，While up to 10% of CIA need rescue analgesia.The overall incidence of PONV was lower than 10%，withgynecologic surgery near 20% (The combine use of 5-HT3 anagonist for prevention of PONV in gynecologic surgery reduced the incidence to 10%)，female of non-gynecologic surgery only 10%，cesarean less than 1%，male of any kinds of surgery less than 5%.One patient developed low oxygenation with SpO2 decreased to 82%，given oxy