胸段和腰段硬膜外腔给药开胸术后镇痛的比较研究  

A COMPARING STUDY OF THORACIC AND LUMBAR EPIDURAL ADMINISTRATION FOR POSTTHORACOTOMY ANALGESIA

作　　者：孟冬祥[1] 樊碧发[2] 刘春霞[1] 曹雷[1] 宋际明[3] 贾乃光[1] 

机构地区：[1]中日友好医院麻醉科,北京100029 [2]中日友好医院疼痛科,北京100029 [3]辽宁鞍钢曙光医院麻醉科

出　　处：《中国疼痛医学杂志》2005年第5期272-274,共3页Chinese Journal of Pain Medicine

摘　　要：目的:比较开胸术后胸段和腰段硬膜外给药的镇痛作用.方法:60例择期开胸手术病人随机分配到胸段(TEA)或腰段(LEA)硬膜外镇痛组,每组30例.麻醉前行T5～6间隙(TEA组)或L1～2间隙(LEA组)硬膜外置管.术毕首先经硬膜外导管推注(8ml),随后持续输注(5ml/h)20μg/ml吗啡溶液.观察TEA和LEA的镇痛效果、额外镇痛药用量、对呼吸功能的影响和不良反应.结果:①LEA组术后咳嗽时疼痛评分与TEA组相比差异无显著性(P＞0.05).②两组病例术后无需额外使用镇痛药.③术后24h和48h FEV1和FVC组间比较无显著性差异(P＞0.05),与术前组内比较差异非常显著(P＜0.01).④术后各时点Ramsay镇静评分和恶心评分组间比较无显著性差异(P＞0.05).结论:吗啡LEA可以作为吗啡TEA的一种替代方法用于开胸术后镇痛.Objective： To compare the analgesic effect between thoracic and lumbar epidural administration for postthoracotomy analgesia. Methods： Sixty patients were randomly allotted to thoracic （TEA） or lumbar epidural analgesia （LEA） groups （n = 30, respectively）. Thoracic （TEA group） and lumbar （LEA group） epidural catheterization were performed before anesthesia. At the end of operation, a starting bolus of 8ml and then a continuous infusion （5ml/h） of 20μ/ml morphine were given via epidural catheter. The effect of TEA and LEA, consumption of extra analgesics, influence on pulmonary function and side effects were observed. Results： ① There was no significant difference in the mean pain scores between LEA and TEA group post operation （PO） when coughing （ P 〉 0.05 ）, ② No patient in both groups needed extra analgesics PO. ③ The mean FEV1 and FVC at 24h and 48h PO had no significant difference between groups （ P 〉 0.05 ）, but there was obvious difference when compared with that of preoperation （P 〈 0.01 ）. ④ The mean Ramsay sedation scores and nausea scores PO had no significant difference between groups （ P 〉 0.05 ）. Conclusion： Morphine LEA may be used as an alternative to morphine TEA for postthoracotomy analgesia.

关 键 词：开胸手术 术后镇痛 硬膜外 吗啡 开胸术后 硬膜外腔给药 腰段 胸段 RAMSAY镇静评分 显著性差异 

分 类 号：R614[医药卫生—麻醉学]