肺癌术后硬膜外患者自控镇痛的临床观察  

Comparison between Patient-controlled Epidural Analgesia (PCEA) with Patient-controlled Intravenous Analgesia (PCIA)after Operation on Lung Cancer

作　　者：马长青[1] 周鹏[1] 

机构地区：[1]天津医科大学附属肿瘤医院麻醉科,天津市300060

出　　处：《中国肿瘤临床》2005年第15期883-884,888,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:比较硬膜外自控镇痛与静脉输注自控镇痛的效果及不良反应。方法:选择60例ASAⅠ～Ⅱ级择期肺癌手术的患者,随机分为两组。I组30例,硬膜外自控镇痛(PCEA)。采用中美合资珠海福尼亚镇痛泵,以1.2%浓度利多卡因,最大输注量13ml/h输入硬膜外腔。Ⅱ组30例,静脉输注自控镇痛(PCIA),同样采用以上镇痛泵,以芬太尼0.3μg/(kg·h)锁定速率1ml/h(自控镇痛1ml/15min)输入静脉。镇痛质量评定优:有效咳嗽无痛;良:有效咳嗽轻度疼痛,可以忍受;中:需要额外辅助镇痛药的有效咳嗽;差:伴随呼吸持续疼痛,睡眠受干扰,必须加用镇痛药、镇静药。同时观察头晕、恶心呕吐、搔痒、呼吸抑制及其他各项生命指标。结果:PCEA组:优+良26例,占86.7%,中3例,差1例因术后1天硬膜外导管脱出未记录在内。3例恶心呕吐,占10%。其他生命指标正常。PCIA组:优+良11例,占36.6%,中19例,占63.3%。头晕、恶心呕吐等不良反应23例,占76.6%。其他生命指标正常。结论:PCEA用于肺癌术后控制疼痛效果确切,优于静脉输注自控镇痛,且不良反应轻。Objective： To compare the curative effect and adverse reaction of patient-controlled epidural analgesia （PCEA） with that of patient-controlled intravenous analgesia （PCIA）. Methods： Sixty patients undergoing elective surgical treatment of lung cancer were randomly assigned to two group. In the PCEA group, 1.2% lidocaine was infused to epidural space at a rate of 5 ml/h and a bolus of 2 ml/15 rain interval time. In the PCIA group, fentanyl was infused intravenously at lock rate of 0.3μg/（kg·h） （1ml）, and a bolus of 1 ml/15 rain interval. The degree of pain control was evaluated at four levels, i.e. grade 1 with effective expectoration and no pain; grade 2 with effective expectoration and light pain;grade 3 with rescue drug to relief the pain during effective expectoration and grand 4 with continuous pain as breath and sleep was interfered. Additional treatment sedation and analgesia was needed. Physical sign and unwanted side effect were also recorded. Results： In the PCEA group patients with grade 1 or 2 accounted for 86.7% （20/30）, and patients with grade 3 （3） and grade 4 （prolapse of epidural tube was not recorded）. The incidence of nausea and vomiting was 10% （3/30） in PCEA. In the PCIA group pain-relief patients with grade 1 or 2 accounted for 36.6% （11/30） only. The incidence of dizziness, nausea and vomitting was 76.6% （23/30） and the other sign was normal. Conclusion： The effect of PCEA is better than that of PCIA in pain control after surgical treatment of lung cancer.

关 键 词：肺癌 PCEA 有效咳嗽排痰 

分 类 号：R614[医药卫生—麻醉学]