目的分析硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA)用于开胸手术患者术后镇痛的效果。方法选取2012年4月至2013年1月收治的100例需行开胸手术患者,随机将这些患者分为两组,即PCEA组和PCIA组,每组50例。对两组患者的镇痛效果进行比较分析。结果 PCEA组患者术后2 h静止状态下和术后6 h、24 h活动状态下的视觉模拟疼痛评分(VAS)明显比PCIA组患者低,术后24 h、48 h的Ramsay评分明显比PCIA组患者低,肺感染、恶心呕吐、切口感染、术后谵妄发生率明显比PCIA组患者低,术后住院时间比PCEA组患者短,差异具有统计学意义(P0.05)。结论 PCEA较PCIA用于开胸手术患者术后镇痛具有更好的效果,值得推广。

Objective To analyze the effect of epidural analgesia(PCEA)and intravenous analgesia(PCIA)for postoperative analgesia of thoracic surgery patients. Methods 100 cases of thoracic surgery patients who had been treated in our hospital from April 2012 to January 2013 were selected. They were randomly divided into two groups,namely patient - controlled epidural analgesia(PCEA group)and intravenous analge-sia group(PCIA group),50 cases in each group. Analgesic effect of two groups of patients were compared. Results The VAS score postoperative 2 h stationary state and the active state after 6 h,24 h of PCEA group were significantly lower than those of PCIA group. The Ramsay score postop-erative 24 h,48 h of was significantly lower than that of PCIA group. The occurance rates of lung infection,nausea and vomiting,wound infection, postoperative delirium were significantly lower than those of PCIA group. The postoperative hospital stay was shorter than that of PCEA group. The differences were st

目的：观察不同镇痛方法对剖宫产术后产妇的镇痛效果,评价其安全性、有效性及经济成本。方法：180例我院拟行剖宫产手术的初产妇,随机分为6组（n=30）,采用患者自控硬膜外镇痛（PCEA）或自控静脉镇痛（PCIA）。1PCEA-RS组：0.2%罗哌卡因复合舒芬太尼0.5μg/ml,2PCEA-RT组：0.2%罗哌卡因复合曲马多8 mg/ml,3PCEA-RF组：0.2%罗哌卡因复合芬太尼5μg/ml,4PCIA-S组：舒芬太尼0.5μg/ml,5PCIA-T组：曲马多8 mg/ml＋格拉斯琼3 mg,6PCIA-F组：芬太尼5μg/ml。注射速度2 ml/h,PCA量0.5 ml,锁定时间15 min,观察并记录患者术后的疼痛评分、恶心呕吐、肢体麻木、尿潴留等不良反应。结果：各组产妇在术后各时段的VAS评分、满意度、PCA次数上相比差异无统计学意义（P〉0.05）;PCEA组镇痛成本明显高于PCIA组（P〈0.05）;PCEA组产妇肢体麻木明显多于PCIA组。结论：硬膜外和静脉自控镇痛都可有效缓解剖宫产术后产妇伤口疼痛,静脉镇痛更利于产妇活动,照顾婴儿,极少有镇痛泵意外脱落,有较高的满意度,且成本低。

Objective To compare the effect of different methods of analgesia on maternal after cesarean section,and to evaluate the safety,effectiveness and economic costs. Method 180 primiparaes undergoing cesarean section in our hospital were randomly divided into six groups(n=30),patient-controlled epidural analgesia(PCEA)or intravenous analgesia(PCIA)was performed in each group as fol-lows.① PCEA-RS group :combination of 0. 2% ropivacaine and sufentanil 0. 5 μg/ml,② PCEA-RT group :combination of 0. 2%ropivacaine and tramadol 8 mg/ml,③ PCEA-RF group :combination of 0. 2% ropivacaine and fentanyl 5μg/ml,④PCIA-S group:sufentanil 0. 5μg/ml,⑤PCIA-T group:combination of tramadol 8 mg/ml and granisetron 3 mg,⑥ PCIA- F group:fentanyl 5 μg/ml. The flow rate was 2 ml / h,the PCA volume was 0. 5 ml,the lockout time was 15 min. To observe and record postoperative pain scores, nausea,vomiting,numbness,urinary retention and other adverse reactions. Results There were no significant diff

探讨吗啡静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)对老年患者在靶控输注(target control infusion,TCI)全凭静脉麻醉(total intravenous anesthesia,TIVA)下行腹部手术后早期认知功能的影响。方法:120例符合入选标准的老年患者随机分为吗啡PCIA组和对照组,每组60例。两组患者均在TCI/TIVA下行腹部手术,均于术后24 h、48 h进行疼痛视觉模拟评分(visual analogue scale,VAS);术前24 h及术后24 h、48 h、72 h用简易精神状态量表(mini-mental state examination,MMSE)行神经心理学检查,评价认知功能;记录术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率。结果:术后24 h和48 h PCIA组VAS评分显著低于对照组(P0.01);术后72 h PCIA组POCD发生率低于对照组(P0.05),且术后认知功能恢复情况优于对照组(P0.05)。结论:吗啡PCIA可减少老年患者在TCI/TNA下行腹部手术后POCD的发生,并促进术后认知功能的恢复。

Objective:To explore the influence of patient-controlled intravenous analgesia(PCIA)with morphine on early post-operative cognitive function in the elderly patients undergoing abdominal surgery with target control infusion(TCI)/total intra-venous anesthesia(TIVA).Methods:A total of 120 patients matched with the inclusion criteria were randomly divided into PCIA group with morphine(n=60)and control group(n=60).All the patients underwent abdominal operation with TCI/TI-VA.Pain intensity at 24 h and 48 h after the operation were evaluated by visual analogue scale(VAS).Mini-mental state examination(MMSE)scores were recorded at 24 h before the operation and 24 h,48 h,72 h after the operation,in order to as-sess cognitive function and incidence of POCD.Results:Scores of VAS in PCIA group were significantly lower than those in control group at 24 h and 48 h after the operation(P <0.01).The incidence of postoperative cognitive dysfunction(POCD)at 72 h after the operation in PCIA grou

目的探讨两种不同镇痛方法用于前列腺切除术后的镇痛效果。方法60例前列腺切除病人随机分为两组，A组术后采用PCEA镇痛；B组采用PCIA镇痛，观察两组病人术后48hVAS评分，膀胱痉挛次数、膀胱冲洗量。结果 A组镇痛效果优于B组。结论 PCEA用于前列腺切除术后镇痛优于PCIA，且不稳定膀胱发生率低。

Object to discuss the analgesic effect of two analgesia after prostatectomy.Methods 60 cases of patients after prostatectomy were randomly divided into 2 groups,group A using PCEA analgesia,group B using PCIA analgesia.VAS score including the frequency of bladder spasm and the flushing quantity were recorded.Results the analgesic effect of group A is better than B.Conclusion PCEA used for analgesia after prostatectomy produces better analgesia than PCIA,and the incidence of unstable bladder was low.

目的：探讨芬太尼及右美托咪定在老年下肢骨折患者术后自控静脉镇痛（PCIA）的临床效果。方法将本院骨科收治的84例老年下肢骨折切开复位内固定治疗的患者随机分为观察组和对照组，每组各42例。观察组患者采用右美托咪定进行术后PCIA，对照组患者采用芬太尼进行术后PCIA，比较两组患者术前、术后1、4、8、12、24、48小时的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）变化情况及上述不同时间点的视觉模拟评分法（VAS）评分、PCIA按键次数及不良反应发生情况。结果观察组患者术前、术后1、4、8、12、24、48小时SBP、DBP、MAP、HR比较差异无显著性；对照组患者仅HR在术后1、4、8小时较治疗前显著升高（P＜0.05），SBP、DBP及MAP与术前比较差异无显著性；术后1、4、8小时对照组患者HR高于观察组（P＜0.05），其余指标组间比较差异无显著性。术后1、4、8、12、24观察组患者VAS评分均显著低于对照组，差异均具有显著性（P＜0.05）；但术后48小时两组患者VAS评分比较差异无显著性。观察组患者PCIA按键平均次数及不良反应发生率均显著低于对照组（P＜0.05）。结论老年下肢骨折患者予以切开复位内固定治疗后，采用右美托咪定进行术后PCIA的临床效果显著优于

Objective To explore clinical effect of patients controlled intravenous analgesia (PCIA) implementation in elderly patients with lower limb fracture when fentanyl and dexmedetomidine were used. Method 84 patients with lower limbs fractures undergoing internal ifxation of open reduction were randomly divided into observation group and control group with 42 cases in each group. Patients in observation group used dexmedetomidine for PCIA, and patients in control group used fentanyl, compared the changes in SBP, DBP, MAP and HR of patients at 1, 4, 8, 12, 24 and 48 hours and visual analogue scale (VAS) score at different times, keystrokes of PCIA and occurrences of adverse reactions before and after treatment. Result The differences in comparisons of SBP, DBP, MAP and HR of patients in observation group before and after treatment were not statistically signiifcant. Only HR of patients signiifcantly increased in 1, 4 and 8 hours when indexes of patients were compared those before