硬膜外自控镇痛泵对前列腺术后膀胱痉挛临床应用.docVIP

硬膜外自控镇痛泵对前列腺术后膀胱痉挛临床应用 　 作者：荆友科，荆涛，管建民，刘大军，董胜国 【摘要】 目的 研究硬膜外自控镇痛泵（patient-controlled epidural analgesic pump， PCEA）对前列腺增生症（benign prostatic hypoplasia， BPH）术后膀胱痉挛的缓解作用以及对并发症的影响。方法 前列腺增生症（BPH）患者行耻骨上经膀胱前列腺摘除术后196例，随机分为两组并采用不同的术后镇痛方法。PCEA组126例，泵内药液用0.125%布比卡因、5mg氟哌啶、0.4mg芬太尼；对照组70例采用度冷丁、强痛定、氢溴酸高乌甲素或山莨菪碱等常规方法镇痛。记录两组患者手术日及术后3天膀胱痉挛次数、出血情况及术后肠鸣音恢复和肛门排气时间。结果 (1)PCEA组缓解膀胱痉挛作用明显优于对照组（P＜0.001）；(2)PCEA组出血量明显少于对照组（P＜0.001）；(3)两组术后胃肠功能恢复差异无显著性（P＞0.05）。结论 前列腺术后采用PCEA可有效地缓解膀胱痉挛症状，能明显减少并发症，减轻患者痛苦，对老年患者安全度过围手术期有积极的作用。 【关键词】 硬膜外自控镇痛泵；前列腺增生症；膀胱痉挛 【Abstract】 Objective To analyse the remission of PECA ( Patient-Controlled Epidural Analgesic pump) on cystospasm of patients underwent prostatectomy and the affect on post-operative complications.Methods 196 BPH cases were divided into PCEA and control group randomly. Patients of PCEA group were adopted patient-controlled epidural analgesic pump to relieve pains. Whereas patients in control group were given routine analgesic drug injection. Items including cystospasm times on the day of operation and the three days after operation， post- operative hemorrhage， and the recovery schedule of the gastrointestinal function were observed.Results （1）The times of cystospasm in PCEA group were remarkably less than those in control group（P＜0.001）.（2）The quantity of postoperative hemorrhage in PCEA group was notably less than that in control group（P＜0.001）.（3）There is no obvious difference between the PCEA and control group（P＞0.05）.Conclusion Using PECA after prostatectomy may release cystospasm， decrease patients’ post-operative complications. So PCEA is effective for patients’ recovery from prostatectomy. 【Key words】 patient-controlled epidural analgesic pump； benign prostatic hypoplasia； cystospasm 前列腺增生症（BPH）患者行耻骨上经膀胱前列腺摘除术后经常出现膀胱痉挛性疼痛，可使术后继发性出血加重，膀胱冲洗不畅，患者胃肠功能恢复时间延长，然而使用常规镇痛方法疗效却欠佳。自2002年以来，我们对前列腺术后患者采用硬膜外自控镇痛泵（PCEA）持续用药，使膀胱痉挛得到缓解，取得良好临床镇痛效果，并发症明显减少，现报告如下。 1 资料与方法 1.1 一般资料 本组资料BPH患者196例，年龄55～76岁，平均67.5岁；伴高血压80例，冠心病72例，糖尿病32例，慢性肺气肿66例