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目的比较皮下患者自控镇痛(PCA)和静脉PCA在高龄肿瘤患者术后镇痛的应用效果。方法全麻肿瘤手术患者99例,年龄80~92岁。术后镇痛:S组61例,采用皮下PCA,于手术结束前约1h行上臂三角肌前区皮下穿刺留针,连接无线镇痛泵;I组38例,术后实施静脉PCA。镇痛药配方:S组,舒芬太尼7μg/kg+0.75%左布比卡因20ml+雷莫司琼0.6mg+0.9%氯化钠至150ml;I组,舒芬太尼5μg/kg+雷莫司琼0.6mg+0.9%氯化钠至150ml。镇痛方法:背景剂量1.5ml/h,PCA单次量1.2ml,锁定时间10min。评估术后2、24和48h的数字等级评分量表(NRS)评分,记录不良反应。结果两组术后镇痛效果满意,各时点NRS评分相仿(P>0.05)。S组患者镇痛期嗜睡、恶心呕吐、低血压发生率低于I组(P<0.05)。结论与静脉PCA比较,高龄肿瘤患者术后使用皮下PCA镇痛效果相仿,但使用方便,对全身影响较小。
Objective To compare the effect of postoperative analgesia with subcutaneous PCA and PCA in elderly patients. Methods Totally 99 patients underwent general anesthesia for tumor surgery, aged from 80 to 92 years. Postoperative analgesia: In group S, 61 cases were treated with subcutaneous PCA. The rabbits were subcutaneously punctured with needles and connected to the analgesia pump at about 1 hour before the end of surgery. Group I (38 cases) received intravenous PCA. Analgesic formula: S group, sufentanil 7μg / kg + 0.75% levobupivacaine 20ml + ramosetron 0.6mg + 0.9% sodium chloride to 150ml; I group, sufentanil 5μg / kg + thunder Mozastom 0.6mg + 0.9% sodium chloride to 150ml. Analgesic method: Background dose 1.5ml / h, PCA single amount 1.2ml, lock time 10min. The NRS scores at 2, 24, and 48 h after surgery were assessed and the adverse reactions recorded. Results The postoperative analgesia was satisfactory in both groups, with similar NRS scores at all time points (P> 0.05). Patients in group S had lethargy, nausea and vomiting during the analgesic period, and the incidence of hypotension was lower than that in group I (P <0.05). Conclusion Compared with intravenous PCA, the efficacy of subcutaneous PCA analgesia in elderly patients with cancer is similar, but it is easy to use and has little effect on the whole body.