肝癌患者肝部分切除术后平衡镇痛的临床观察  

Clinical observation of balance analgesia in patients with liver cancer after partial hepatectomy

作　　者：文玲玲[1] 

机构地区：[1]中南大学湘雅三医院麻醉科,湖南长沙410013

出　　处：《现代医药卫生》2013年第6期803-804,共2页Journal of Modern Medicine & Health

摘　　要：目的观察肝癌患者肝部分切除术后硬膜外布比卡因(丁哌卡因)注射液、丁丙诺啡注射液和盐酸格拉司琼(格雷司琼)注射液平衡镇痛效果及不良反应。方法选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行肝部分切除术肝癌患者30例,随机分为两组,每组15例。Ⅰ组镇痛液为0.25%布比卡因、盐酸格拉司琼5 mg,Ⅱ组为0.18%布比卡因、0.000 6%丁丙诺啡、盐酸格拉司琼5 mg,均以生理盐水配成100 mL,术后行硬膜外自控镇痛,术后8、12、24、44 h行视觉模拟评分法(VAS)评分,并对有效按压次数、用药量及不良反应发生情况进行观察比较。结果Ⅱ组患者术后各时间点VAS评分、有效按压次数、用药量均小于Ⅰ组(P<0.05),提示硬膜外患者自控镇痛(PCEA)联合用药的镇痛效果优于单一用药,两组患者不良反应发生率无明显差别。结论布比卡因注射液、丁丙诺啡注射液和盐酸格拉司琼注射液三药联用的平衡镇痛法镇痛效果好,尤其对肝癌患者肝部切除术后的剧痛有明显镇痛作用,且不良反应少。Objective To observe the effect and adverse reaction of balance analgesia of bupivacaine combined with tropisetron and buprenorphine by epidural analgesia on the patient with liver cancer after partial hepatectomy.Methods 30 ASA physical status Ⅰ-Ⅱ patients with liver cancer undergoing partial hepatectomy were randomly divided into two groups,15 cases in each group.The analgesic formula of patient-controlled epidural analgesia（PCEA） after operation was 0.25% bupivacaine plus tropisetrona 5 mg in the group Ⅰand 0.18% bupivacaine plus 0.000 6% buprenorphine plus tropisetrona 5 mg in the group Ⅱ,which was diluted with 0.9% NS to 100 mL.The visual analogue scores（VAS）,the effective time pressing PCEA,drug consumption and the side effects at postoperative 8,12,24,44 h were observed and compared between the two groups.Results The VAS scores,effective pressing times and analgesic drug consumption at various time points in the group Ⅱ were apparently lower than those in the groupⅠ（P0.05）,which hinted that the analgesic effect of combination medication was better than that of single drug.The incidence rate of adverse reactions had no significant difference between the two groups.Conclusion The balance analgesia of bupivacaine combined with tropisetron and buprenorphine has better analgesic effect,significant analgesic effect and fewer adverse reactions especially for the patients with severe pain after partial hepatectomy.

关 键 词：肝肿瘤 外科学 肝切除术 疼痛 手术后 预防和控制 镇痛 布比卡因 丁丙诺啡 格兰塞隆 

分 类 号：R657.3[医药卫生—外科学]