胸部硬膜外阻滞在心脏开胸手术术后镇痛的临床研究  

Clinical research of thoracic epidural anesthesia for patient controlled postoperative analgesia after thoracotomy

作　　者：周新[1] 程红[2] 

机构地区：[1]山东大学附属省立医院麻醉科,山东济南250021 [2]山东大学附属济南市中心医院麻醉科,山东济南250013

出　　处：《四川医学》2010年第3期344-346,共3页Sichuan Medical Journal

摘　　要：目的探讨心脏开胸手术中采用胸部硬膜外阻滞(TEA)术后镇痛的效果及不良反应。方法30例拟行心脏开胸手术的患者分为观察组和对照组。观察组采用硬膜外腔术后镇痛,对照组采用阿片类药物镇痛。观察术前(T1)、术后拔管完全清醒时(T2)、术后24h(T3)、48h(T4)两组患者血压、脉搏血氧饱和度(SpO2)、平均动脉压(MAP)、呼吸频率(RR)、心率(HR)变化及可察觉的不良反应。结果两组患者在T1时点血压、MAP、HR、RPP值变化比较差异无统计学意义(P>0.05),在T2、T3、T4时点观察组的SBP、DBP、MAP、HR、RPP值显著低于对照组(P<0.05)。而两组患者在各时点SpO2、RR比较差异无统计学意义(P>0.05)。两组术后均有患者出现恶心、呕吐等症状,观察组有2例(13.3%)患者于术后出现S-T段改变,对照组患者术后有12例(80.0%)患者出现S-T段改变。结论开胸手术采用TEA术后镇痛效果确切,不良反应少,具有重要的临床价值。Objective To evaluate the effects and side effects of thoracic epidural anesthesia（TEA） for patient controlled postoperative analgesia after thoracotomy.Methods 30 cases of patients proposed thoracotomy were divided into observation group and control group.Observation group were given TEA postoperative analgesia,the control group were given opioid postoperative analgesia.The blood pressure,SpO2,MAP,RR,HR and detect toxicity of the two groups＇ patients were observed in the preoperative（T1）,postoperative extubation fully awake（T2）,after 24h（T3） and 48h（T4）.Results At T1 point the blood pressure,MAP,HR and RPP change of the two groups was no significant difference（P〉0.05）,at T2、T3、T4 point the SBP,DBP,MAP,HR and RPP of the observer group were significantly lower than that of the control group（P〈0.05）.The two groups＇ patients at each time point the SpO2and RR difference was not statistically significant（P〉0.05）.Both groups＇ patients appeared postoperative nausea,vomiting and other symptoms.2 cases（13.3%） patients of the observation group occurred ST segment changes in the postoperative and the control group had 12 cases（80.0%） patients with ST segment changes.Conclusion The TEA for patient controlled postoperative analgesia after thoracotomy has better effect and important clinical value.

关 键 词：胸部硬膜外阻滞 术后镇痛 心脏开胸手术 

分 类 号：R614.2[医药卫生—麻醉学]