| Objective: To exploration the effect of gastricintestinal function recovery by patient controlled intravenous analgesia after abdominal operation.Method: 120 patients with abdominal operation in our hospital during April 2007-Janury 2008 were selected. In these cases, 78 cases were male and 42 cases were female., They were 18-81 years old, with an average of 49.7±5.6 years old and average weight of 53.2±6.5kg .Among them there were 30 cases were above 60 years, with an average age 70.3±4.8 and average weight of 58.6±12.1kg. All the patients were randomly divided into two groups: the experimental group adopted patient controlled intravenous analgesia(PCIA)(60 cases), the control group adopted muscle injection of analgesic at certain interval. The variety of operation consisted of epigastrium operation and hypogastric zone operation. Among them, there were 34 cases of operation in stomach intestine ,4 cases of operation in pancreas and duodenum, 16 cases of operation in small intestine, 4 cases of operation in liver, 28 cases of operation in biliary tract and 8 cases of operation in spleen. There were 12 cases of operation in colon, 14 cases of operation in rectum of hypogastric zone and pelvic cavity. Anesthesia method: All the patients were injected agrypnal 0.1g, atorpin 0.5mg before the operation, who had no the history of long-term application analgesics. All of them applied to tracheal intubation and vein combined anesthesia. The practical drugs of anesthesia induction were consisted of Fentanyl 5μg/ kg, vecuronium bromide 0. 1mg/ kg, midazolam0.1g/ kg,and propofol 2mg/ kg. The full mask oxygen and air chane were given for endotracheal intubation,then the OHMEDA210 anesthesia machine controled the respiratory, and anesthesia maintained by giving discontinuously entanyl, vecuroniumbromide and inhaling isoflurane. The operations continuted above 2 hours.All the patients returned the yard after anesthesia conscious and the extubation duration . Analgesia method of per group:In the PCIA group the disposable PCIA pump was applied after operation. The prep of PCIA was fentanyl 0.5-0.1mg, nefopam 100-160mg, then all were soluted in sodium chloride 100ml, stopped relieving pain after 48-72h after operation. After the patients of the control group arrived.The duty doctors applied meperidine (once 50mg) or AP237 ( once 50mg) by muscle injection according to the situations. Materials and Methods: The time for bowel sound recovery in patients after operation was observed. The method was to observe the bowel sound every 4 hour after operation, till the first bowel sound showed, and the time of observation was 3 minutes every time .The leaving hospital standard of patients: the diet had recovered the normal universal food,the incisin had no infection and been clearing,and the end of analgesia recorded the patient satisfaction of analgesia effect .Results: The constitute of sex, years of age, weight, and duration of opetation time had no significant difference between the 2 groups (P>0.05). The analgesia effect :the satisfaction of the patients after operation, there were 48 patients with excellent satisfaction, 9 patients with less excellent and 3 patients with ineffective in the PCIA team; while there were 33 patients with excellent satisfaction 21 patients with less excellent and 6 patients with ineffective in the control team, the satisfaction had significant difference between the two groups (P<0.05). I n the PCIA group 9 patients had adverse reaction,while in the control group 26 patients had adverse reaction,the rate of adverse reaction of the control group was higher than that of PCIA group (P<0.05) .There were significant differences of the time for bowel sound recovery between the 2 groups(P<0.05). The first time of bowel movement and defecation had significance difference between the 2 groups (P<0.05). The time for bowel sound recovery and the first time of bowel movement and defecation of the old patients above 60 years old had not significant difference between the 2 groups ((P>0.05)).Conclusion: The analgesia effect of patient controlled intravenous analgesia is significantly better than that of control group, and can enhance the early recovery of gastrointestinal function. But there is no obviously effect on the final recovery gastrointestinal function of the patients above 60 years old. |
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