胸腔切開手術後病人自行控制與傳統止痛方式之比較

Efficiency of Patient-Controlled Analgesia versus Conventional Analgesia in Patients after Thoracotomy

王忠訓(Chung-Shan Wang) ； 周毅鵬(Yi-Pen Chou) ； 侯清正(Ching-Cheng Hou) ； 李繼源(Chi-Yuan Li) ； 林炳煌(Bing-Huang Lin) ； 顏復華(Fu-Wa Yen)

《Acta Anaesthesiologica Sinica》 29卷2期 (1991/06) Pp. 604-609

摘要

本研究是以二種不同的止痛方式應用於胸腔切開手術後病人，觀察其對疼痛減輕程度，夜間睡眠狀況及其對肺功能的影響。26位接受胸腔切開手術的病人分為2組，肌肉內注射組（n＝13）於手術從接受傳統肌肉內注射meperidine止痛劑（50mg，q4h，prn）止痛。PCA組（n＝13）是以PCA（patient-controlled analgesia）方式控制疼痛；兩組病人皆以VAPS（visual analogue pain scale）評估疼痛狀況，每4小時記錄1次，觀察2天，並於手術前及手術後第1及2天早晨測定病人的肺活量（forced vital capacity，FVC），並詢問病人夜間睡眠狀況。結果顯示胸腔切開手術後的病人，PCA組的止痛方式確實優於傳統肌肉注射，病人可得到較好的疼痛控制及夜間睡眠，且肺功能恢復程度較佳。

關鍵字

Meperidine ； Patient-controlled analgesia ； Postoperative analgesia

並列摘要

The patients received thoracotomy usually suffered from significant severe pain postoperatively, which accompanied with impaired plumonary function or increased incidences of atelectasis and pneumonia. So adequate analgesia for those patients is indicated. The purpose of this study is to investigate the efficiency of patient-controlled analgesia (PCA) and determine whether it is better than conventional analgesia or not. Twenty-six patients, ASA physical status class I and II, were randomized into two groups: PCA and intramuscular (IM). The effect on pain relief was assessed by a visual analogue pain scale (VAPS) q 4 h postoperatively for two days. Forced vital capacity (FVC) and the questionnaire of nocturnal sleep disturbance by pain were evaluated preoperatively, the first, second postoperative mornings. As result of this study, the patients of PCA group get less pain than IM group after the first and second days of surgery. VAPS values are 3.7 ± 1.1, 2.8 ± 0.8 and 6.1 ± 0.9, 5.3 ± 1.1 respectively pertaining to PCA and IM groups (p＜0.05). The patients of IM group get more disturbance of noctural sleep than PCA group at initial two nights of postoperation as well (p＜0.05). It is manifest to look out the significant difference between these two groups in accordance with FVC ratio records of post-surgery vs pre-surgery at initial two days after surgery on the subject of respiratory function recovery. PCA group are 46.46 ± 7.29%, 52.25 ± 8.32% in a condition of more progress on lung function recovery than IM group of 38.13 ± 10.25%, 42.15 ± 7.82% (p ＜0.05). We conclude that PCA gave better pain relief, lower interference with nocturnal sleep, greater pulmonary function recovery than IM meperidine in patients after thoracotomy.