For transurethral resection of the prostate vaporization-controlled analgesia pump in patients with the effect of observation network to write papers _

Network to write papers: Author: Shih-Wei Lai Zhouzheng Yang Peng Libin Chen Qiao ZX

[Abstract] Objective: To observe, compare PCA analgesia and rectal analgesia (RAA) in the transurethral vaporization resection of the application results in patients Methods: Two patients of the 90 cases observed in patients with analgesic effects, sleep, and bladder spasm, etc. Results: PCA group after 2h, 6h, 12h, 24h, 48h analgesic effect superior to RAA group (P <0.01), 24h in patients with sleep longer than the RAA group (P <0 .01), significantly lower than the number of bladder spasms RAA group (P <0.01). CONCLUSION: Transurethral resection of the prostate transurethral application of PCA sedative, analgesic effect is good, safe, few side effects, but also to reduce bladder spasms, contraction, wound oozing play with good results.

[Keywords] PCA pain pump, benign prostatic hyperplasia; resection, postoperative pain

Surgery, postoperative pain is the body's tissue damage and pain caused by a complex physiological response, not only to patients with wounds caused by mental combat, and can cause respiratory, circulatory and endocrine disorders, metabolic disorders [1], which kinds of changes often lasted several days, even weeks, seriously affected the outcome. analgesia has become to reduce patient suffering, improve quality of care and promote early recovery after an important part of .2009 March to March 2011, We are 90 cases of transurethral vaporization resection patients controlled analgesia (PCA for pain treatment, and achieved good results, reported below.

1 Subjects and methods
1.1 The study: March 2009 to March 2011 in our hospital transurethral vaporization resection of the prostate in patients with benign prostatic hyperplasia 180 patients aged 35 to 87 years, duration of 2 years to 15 years, an average of 3 years to 7 years. hypertension in 32 cases, 21 cases of coronary heart disease, emphysema, chronic bronchitis, 19 cases of diabetes in 24 cases. All patients had no history of drug allergy pain, no neurological, mental illness, to correctly understand the visual analogue scale (VAS) Rules and the PCA pump use. 180 patients were randomly divided into study group and control group, 90 cases of postoperative analgesia were used to pump (PCA group), and rectal administration of analgesia (RAA group) .2 group of patients age, sex, disease, and no significant difference in operative time, are used anesthesia (endotracheal intubation + intravenous), anesthesia is no different.

1.2 analgesia: The study group used the PCA pump Zhuhai production capacity of 100mL. Analgesia before using the PCA pump to inform patients and their families with the purpose of PCA pump therapy, the role of theory and use, so that patients understand the PCA analgesia Although effective, but not pain, not pain free in no significant increase in the number of keys, so as not to increase adverse drug reactions. on post-operative loading dose (intravenous tramadol 100 mg) after connecting the PCA pump, the drug dose is: fentanyl lmg, tramadol 300mg, adding normal saline to 100 ml, infusion rate 2 ml / h, self-control needed by the patient after injection, a volume of 0.5-1 ml. back to the ward the end of the control group after surgery , lower limb muscle tone is restored, to give a plug to diclofenac sodium suppository rectal pain deep in 7 ~ 8cm Department, pain can be reused.

1.3 OUTCOME MEASURES:
1.3.1 analgesia: the use of visual analog scale method similar score (VAS) for resting pain scores were recorded after 2,6,12,24,36,48 h pain scores.

1.3.2 sleep time: within 24h after sleep will be divided into good, fair, poor, 24 h sleep time> 6 h as well, 4 ~ 6 h for the general, 4h less for the poor.

1.3.3 Bladder spasm: The record after 24h, 48h number of bladder spasms. Bladder spasm Rating: conscious bladder bulge, irritation evident, there is urgent urination, persistent 30s or so, that record bladder spasm 1.

1.4 Statistical Methods: All data with SPSS11.0 for statistical analysis, test level a = 0.05. Count data using chi-square test, measurement data, the data used by mean + - standard deviation (x +-s) that samples comparison between the number of t-test,
2 Results
Postoperative pain score of 2.1 compared to Table 1 Table 12 Comparison of postoperative pain score
Links to free download http://www.hi138.com 2.2 postoperative sleep compared in Table 2.


3 Discussion
Perioperative pain and other stress response, postoperative complications and mortality is an important factor, therefore, help to improve postoperative analgesia and postoperative recovery security [2].

Transurethral resection of prostate vaporization is a safe and effective treatment of benign prostatic hyperplasia a good method, but the continued traction indwelling catheter and continuous bladder irrigation pressure can cause the bladder to stimulate the paroxysmal spasms of pain, the incidence of bladder spasm 90% pain and pressure pain stimulus pain patients are often led to delayed postoperative bleeding and recovery [3], can be harmful to the pain stimulus start neuroendocrine responses, causing the release of many hormones in vivo, to produce changes in the pathophysiology clinical pain again on the usual method of administration can not effectively prevent the stress response.

PCA pumps continue to use drugs in patients with intravenous drug injection, or the patient feels pain when pressing the start button to set the dose injected into the body of analgesic drugs, to patients under different conditions of individual analgesic demand, to maintain stable plasma concentration, a small dose, to maximize the analgesic drugs to avoid toxicity, the patient more relaxed and comfortable to spend the postoperative pain point, greatly improving the postoperative quality of life, and drugs can be predicted dilution , will not be cold, hypovolemia or shock while changing the intravenous PCA fentanyl in opioid drugs is most commonly used clinical narcotic analgesics and analgesic effects, and can be excited to the spinal cord, medulla oblongata, midbrain and thalamus pain transmission areas such as opioid receptors, so that the body pain threshold. within tramadol non-opioid drugs have an affinity for opioid receptors, two drugs in the body can better enhance the analgesic effect of rectal administration of analgesic give pain diclofenac sodium suppository, the main component of diclofenac, which inhibit the ring chlorine fun activity, decreased production of the prostate, inhibit the hypothalamic center of the nerve endings of nociceptors in peripheral nerve endings and reduce the response to injury to know the sensitivity of sexy.

Good postoperative analgesia can inhibit the body's stress response is conducive to postoperative respiratory, circulatory stability, and reduce postoperative complications, functional recovery of the body to speed up the patient [4] Our data show that, PCA analgesia received to the satisfaction of sedation, analgesia, after 2h, 6h, 12h, 24h, 48h pain scores than the control group, the difference was significant (P <0.05, P <0.01), bladder spasm rate was significantly lower than the control group, patients with sleep state has been very good improvement, two groups, the difference was statistically significant (P <0.01).

PCA analgesic has a simple, safe, adverse reactions and have an effective advantage, but Medical staff should be noted that when used to enhance observation, within 6 h after close attention to patient breathing, pulse, blood pressure, oxygen and other changes. For the elderly patients suffering from heart and lung disease, analgesic drug concentration to be low, strengthen surveillance, prevent the occurrence of various complications.

References
[1] Liudan Li, Cai clouds abdomen after surgery the patient-controlled analgesia pump with clinical observation. Medical Journal of new knowledge, 2010,20 (1) :53-54
[2] Li Zhonglian, editor. Clinical Pain Therapy [M]. Tianjin Science and Technology Press, 2000:437
[3] Feng Xiaoli, Xiao-Mei Chen. Epidural analgesia after transurethral vaporization of prostate and nursing care. Chinese Journal of Health Psychology, 2008,20 (2): 138
[4] establish a new section. Analgesia in patients after the application of observation and care. Modern medicine, 2009,15 (27): 119 Links to free download http://www.hi138.com