CAJ | 학술논문

目的：比较膝关节置换术后患者皮下注射吗啡患者自控镇痛（ PCSA）与静脉注射吗啡患者自控镇痛（ PCIA）在术后镇痛中的效果及安全性。方法选取行择期人工全膝关节置换术的患者60例，按数字表法随机分为PCIA组30例、PCSA组30例，两组患者均在硬膜外麻醉下完成手术。 PCIA组与PCSA组单次给药剂量分为1 mg／次、2．5 mg／次，锁定时间分为5 min、20 min，在术后感知疼痛时，由患者自己给药镇痛。于术后4 h、8 h、12 h、24 h记录患者吗啡用药量、用药次数、疼痛评分（ VAPS）、平均动脉压和呼吸频率、镇静程度，比较两组镇痛效果。结果 PCSA组术后24 h用药总量为（30．41±10．00） mg，显著高于PCIA组的（18．03±6．04）mg，两组差异有统计学意义（t＝3．98，P＜0．05）；但术后各时间点两组患者平均用药量差异均无统计学意义（均P＞0．05）。 PCIA组术后0～4 h、＞4～8 h镇痛效果、镇静程度均优于PCSA组（t＝3．4、3．2、3．5、3．7，均P＜0．05），PCIA组恶心、呕吐发生率为30％，高于PCSA组的12％，两组差异有统计学意义（χ2＝5．76，P＜0．05）。结论两种镇痛方法均具有良好的镇痛效果，但PCSA镇痛起效较慢，不良反应较小，在开始PCSA前应给予负荷剂量，以提高其早期镇痛效果。
목적：비교슬관절치환술후환자피하주사마배환자자공진통（ PCSA）여정맥주사마배환자자공진통（ PCIA）재술후진통중적효과급안전성。방법선취행택기인공전슬관절치환술적환자60례，안수자표법수궤분위PCIA조30례、PCSA조30례，량조환자균재경막외마취하완성수술。 PCIA조여PCSA조단차급약제량분위1 mg／차、2．5 mg／차，쇄정시간분위5 min、20 min，재술후감지동통시，유환자자기급약진통。우술후4 h、8 h、12 h、24 h기록환자마배용약량、용약차수、동통평분（ VAPS）、평균동맥압화호흡빈솔、진정정도，비교량조진통효과。결과 PCSA조술후24 h용약총량위（30．41±10．00） mg，현저고우PCIA조적（18．03±6．04）mg，량조차이유통계학의의（t＝3．98，P＜0．05）；단술후각시간점량조환자평균용약량차이균무통계학의의（균P＞0．05）。 PCIA조술후0～4 h、＞4～8 h진통효과、진정정도균우우PCSA조（t＝3．4、3．2、3．5、3．7，균P＜0．05），PCIA조악심、구토발생솔위30％，고우PCSA조적12％，량조차이유통계학의의（χ2＝5．76，P＜0．05）。결론량충진통방법균구유량호적진통효과，단PCSA진통기효교만，불량반응교소，재개시PCSA전응급여부하제량，이제고기조기진통효과。
Objective To compare the knee of patient controlled subcutaneous injection of morphine analge-sia after hip joint replacement ( PCSA ) and intravenous morphine patient-controlled analgesia ( PCIA ) effect and safety of postoperative analgesia.Methods 60 patients undergoing artificial total knee arthroplasty patients were selected and randomly divided into PCIA group of 30 cases,30 cases in group PCSA, two patients were completed under epidural anesthesia in the operation.Group PCIA and group PCSA single dose divided into 1mg/and 2.5mg/, lock time divided into 5min,20min,in the postoperative pain perception,from the patient's own pain medication.After 4h,8h,12h,24h record patient morphine dosage,frequency,pain score (VAPS),mean arterial blood pressure and re-spiratory rate,compose degree,analgesic effects were compared between the two groups.Results In group PCSA after 24h treatment for the total dose was (30.41 ±10.00) mg,significantly higher than that of group PCIA (18.03 ± 6.04)mg,there was significant difference between the two groups (t=3.98,P<0.05);but after each time point of the two groups of patients the average dosage had no statistically significant difference (P>0.05).PCIA group after 0-4h and >4-8h analgesia and sedation were better than those in PCSA group (t=3.4,3.2,3.5,3.7,all P<0.05), PCIA group,the incidence rate of nausea and vomiting was 30%,higher than 12%in the PCSA group,there was sig-nificant difference between the two groups (χ2 =5.76,P<0.05).Conclusion The two kinds of methods of analge-sia has a good analgesic effect,but PCSA analgesia is slower,less adverse reactions,should be given a loading dose at the beginning before PCSA,in order to improve the early analgesia effect.