Testa G, Borzomati V, Costantini D, De Chiara A, Picarazzi A, Capelli O
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Roma La Sapienza.
Ann Ital Chir. 1996 Mar-Apr;67(2):257-63.
36 patients submitted to interventions for thoraco-abdominal surgery has been submitted to antalgic post-operatory therapy with elastomeric pump at a continuous intravenous infusion and patient controlled analgesia (PCA). The patients have been randomized in three groups. The patients of the 1 degree group received 30 minutes before of the end of the surgical intervention 30 mg of Ketorolac. At the end of the anesthesia came started an infusion of 150 mg of Ketorolac (5 vials) in 60 ml of isotonic chlorinated solution at the rate of 0.5 ml/h. The pump had besides the capability of disperse a maximum of 4 bolus/ h, everyone of 0.5 ml, on demand of the patient. The 2 degrees group received a solution containing 60 ml of Morphine in 60 ml of isotonic chlorinated solution with the same formality of administration. The 3 degrees group (placebo) received 60 ml of isotonic chlorinated solution in pumps from infusion and Ketorolac intramuscular on demand. To the times T0 (awakening), T1 (3 h), T2 (6h), T3 (12 h), T4 (24 h), T5 (30 h, was collected algometrical consequences according to VAS (Visual Analogous Scale of Sc modification of the PA increase, FC, FR, SatO2.. The obtained results have highlighted like in the 1 degree group, to the 1 degree algometric consequence (T0), there is a good sedative effect on the pain (intensity of the middle low pain 3.70 +/- 1.64); this antalgic effect has also continued in the other consequences effected in the post-operatory. In the 2 degree group to the awakening (T0), the pain was middle-tall (5.50 +/- 2.32) and an expressive reduction appeared at the time T2 (3.60 +/- 1.35 P < 0.005). In the 3 degrees group have not recorded a diminution of the pain if not after 24 hours from the end of the intervention deposit the intramuscular antalgic therapy. In conclusion, the system infusion + PCA represents an indubitable advantage in comparison with the traditional antalgic therapy as for concern the entity of the reduction of the pain as because it permits the use of a smaller quality of drugs.
36例接受胸腹手术干预的患者接受了术后镇痛治疗，采用弹性泵持续静脉输注和患者自控镇痛（PCA）。患者被随机分为三组。1度组患者在手术干预结束前30分钟接受30毫克酮咯酸。麻醉结束时，开始以0.5毫升/小时的速度在60毫升等渗氯化溶液中输注150毫克酮咯酸（5瓶）。该泵除了能够根据患者需求每小时最多分散4次推注，每次0.5毫升。2度组接受含60毫升吗啡的60毫升等渗氯化溶液，给药方式相同。3度组（安慰剂组）通过输液泵接受60毫升等渗氯化溶液，并按需肌内注射酮咯酸。在T0（苏醒）、T1（3小时）、T2（6小时）、T3（12小时）、T4（24小时）、T5（30小时）时，根据视觉模拟评分法（VAS）收集疼痛程度、PA增加量、FC、FR、SatO2等疼痛相关结果。所得结果表明，在1度组中，在1度疼痛相关结果（T0）时，对疼痛有良好的镇静作用（中低疼痛强度为3.70±1.64）；这种镇痛效果在术后的其他时间点也持续存在。在2度组苏醒时（T0），疼痛为中高程度（5.50±2.32），在T2时出现明显减轻（3.60±1.35，P<0.005）。在3度组中，直到干预结束后24小时肌内注射镇痛治疗后才记录到疼痛减轻。总之，与传统镇痛治疗相比，输液+PCA系统在减轻疼痛方面具有明显优势，因为它允许使用更少剂量的药物。
