Egbert A M, Lampros L L, Parks L L
University of Kansas School of Medicine, Wichita.
Am J Crit Care. 1993 Mar;2(2):118-24.
To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety.
Randomized, controlled trial of patient-controlled analgesia vs as-needed intramuscular morphine with pre- and postoperative assessments of pain, mental status, narcotic use, anxiety and mood states.
General surgical wards and surgical intensive care unit at a Veterans Administration hospital.
Eighty-three elderly, chronically ill males undergoing major elective surgery.
Subjects randomized to receive postoperative patient-controlled analgesia vs as-needed intramuscular morphine. Pre- and postoperative assessments of State-Trait Anxiety Inventory, McGill-Dartmouth Part IV and Short Portable Mental Status Questionnaire. Pain (using linear analog scale), sedation score and narcotic use assessed every 4 hours for 72 hours.
No differences were found in state anxiety or self-perceived mood states. Postoperative state anxiety was found to relate most closely to preoperative anxiety and postoperative complications, rather than method of analgesia or severity of pain. However, patient-controlled analgesia subjects had significantly improved analgesia and increased satisfaction.
The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.
确定使用患者自控镇痛法与肌内注射相比是否能改善术后心理参数，尤其是焦虑情绪。
患者自控镇痛法与按需肌内注射吗啡的随机对照试验，对疼痛、精神状态、麻醉药物使用、焦虑和情绪状态进行术前和术后评估。
一家退伍军人管理局医院的普通外科病房和外科重症监护病房。
83名接受大型择期手术的老年慢性病男性患者。
将受试者随机分为两组，分别接受术后患者自控镇痛法或按需肌内注射吗啡。使用状态-特质焦虑量表、麦吉尔-达特茅斯问卷第四部分和简易便携式精神状态问卷进行术前和术后评估。每4小时评估一次疼痛（使用线性模拟量表）、镇静评分和麻醉药物使用情况，持续72小时。
在状态焦虑或自我感知的情绪状态方面未发现差异。发现术后状态焦虑与术前焦虑和术后并发症关系最为密切，而非镇痛方法或疼痛严重程度。然而，患者自控镇痛组的镇痛效果显著改善，满意度提高。
与肌内注射相比，使用患者自控镇痛法并未显著改变所测量的心理参数。镇痛效果的改善是药物作用的结果，与心理因素无关。
