患者静脉自控镇痛与患者硬膜外自控镇痛的比较

术后自控镇痛方法有：患者静脉自控镇痛（Patient-controlled Intravenous Analgesia, PCIA）、患者硬膜外自控镇痛 (Patient-controlled Epidural Analgesia, PCEA）、患者区域自控镇痛（Patient-controlled Regional Analgesia, PCRA)、患者皮下自控镇痛 (Patient-controlled Subcutaneous Analgesia, PCSA)、患者自控鼻内镇痛（Patient-controlled intranasal analgesia, PCINA)、芬太尼HCI 电离子渗入疗法经皮系统（Fentanyl Iontophoretic Transdermal System, ITS)和连续椎旁阻滞（Continuous Paravertebral block, CPVB） 等。目前在临床工作中较常使用的主要是PCIA 和PCEA。有研究报道,与PCIA 比较，PCEA 镇痛效果更确切，恶心、呕吐及嗜睡发 生率低；但也有报道认为,与PCEA 相比，PCIA 实施相对方便，同时也可以提供令患者满意的镇痛效果，适用范围更广。目前对于 这两种镇痛方法的效果优劣尚无确切的定论，在此就PCIA 和PCEA的镇痛药物特点、镇痛效果、副反应及对免疫功能和肿瘤患 者远期生存率的影响作一综述。

Comparison the Effects of Patient-Controlled Intravenous Analgesia Versus Patient-Controlled Epidural Analgesia

Patient-controlled intravenous analgesia (PCIA), patient-controlled epidural analgesia (PCEA), patient-controlled regional analgesia (PCRA) and continuous paravertebral block (CPVB) are the major methods for patient-controlled analgesia. PCIA and PCEA are the common postoperative patient-controlled analgesic methods in clinical works. Some studies report that PCEA has better analgesic effect and lower incidence of postoperative drowsiness, nausea and vomitting compared with PCIA. However, PCIA offers satisfactory effect of postoperative analgesia compared with PCEA in other reports. Moreover, the application of PCIA is wider. It is not clear which one is better about the application of PCIA and PCEA during the perioperation period. This review focused on the characteristic of analgesics, postoperative analgesic effect, side effects, immune influence and the long-term survival of patients with cancer about PCIA and PCEA.