复方利多卡因肋间神经阻滞联合PCIA用于胸科患者的术后镇痛  

Application of intraoperative intercostal nerve blockade with compound lidocaine combined with PCIA in patients undergoing thoacotomy

作　　者：倪燕[1] 丁正年[1] 张国楼[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《江苏医药》2011年第6期675-677,共3页Jiangsu Medical Journal

摘　　要：目的探讨复方利多卡因(CL)肋间神经阻滞用于胸科手术后的镇痛效果。方法开胸食管癌根治术患者60例随机均分为CL组、罗派卡因(R组)和单纯静脉镇痛(I组)三组。术毕,CL组和R组分别由术者实施0.8%CL 12 ml或0.375%罗派卡因12 ml肋间神经阻滞,范围包括胸部切口上下两个肋间。三组术后均行患者自控静脉镇痛(PCIA)组。PCIA药物:芬太尼12μg/kg+格拉司琼6 mg,用生理盐水稀释至总量100 ml。记录术后1、4、24、48、72 h视觉模拟评分(VAS)、Prince-Henry(P-H)疼痛评分、镇静评分,并监测生命体征及不良反应。结果 CL、R组各时点VAS和P-H疼痛评分均明显低于I组(P<0.05),而CL组的疼痛评分又明显低于R组(P<0.05)。CL组PCA次数和哌替啶用量均明显少于R和I组。结论关胸前施行CL肋间神经阻滞能明显增强术后镇痛效果,减少术后静脉镇痛药用量。Objective To study the analgesic efficacy of intraoperative intercostal nerve blockade with compound lidocaine in the patients undergoing thoacotomy.Methods Sixty patients undegoing radical surgery of esophageal carcinoma were randomized into 3 groups with 20 cases each.The intercostal nerve block was performed with compound lidocaine（group CL） or ropivacaine（group R） at the end of surgery.The patients in group I were not given intercostal nerve block.All patients in three groups were given patient-controlled intrvenous analgesia（PCIA） with fentanyl 12 μg/kg plus granisetron 6 mg in 100 ml of saline for 24 hours postoperatively.Visure analogue score（VAS） and Prince-Henry（P-H） pain scores were evaluated and vital signs and complications were recorded at 1,4,12,24 and 72 h after operation.Results VAS and P-H scores were significantly lower in group CL than those in groups of R and I,which were lower in group R than those in group I（P0.05）.So did the PCA numbers and pethidine used postoperatively.Conclusion Intraoperative intercostal nerve blockade with compound lidocaine can effectively enhance postoperative analgesia of PCIA and reduce the use of analgesics.

关 键 词：肋间神经阻滞 复方利多卡因 患者自控镇痛 胸科手术 

分 类 号：R614[医药卫生—麻醉学]