自控式胸段硬膜外镇痛对经胸腹两切口食管癌切除术后早期呼吸功能恢复的影响  

Efficacy of Postoperative Thoracic Epidural Analgesia on the Early Recovery of Respiratory Function in Patients Following Esophageal Carcinosectomy by Right Thoracal and Upper Abdominal Double Incisions

作　　者：刘大治[1] 陈晓宇[2] 王宪东[1] 刘方绪 

机构地区：[1]解放军202医院胸心外科,沈阳110003 [2]解放军202医院麻醉科,沈阳110003

出　　处：《解放军医药杂志》2014年第1期81-84,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的观察自控式胸段硬膜外镇痛(PCEA)对经胸腹两切口食管癌切除术后早期呼吸功能恢复的影响。方法选择2009年3月—2013年3月收治的胸中下段食管癌50例,均经右胸及上腹部正中两切口行食管癌切除管状胃食管右胸膜顶吻合术,随机分为观察组28例和对照组22例,对照组术后采用经静脉镇痛泵镇痛(PCIA),观察组术后采用PCEA。两组均于手术前2 d和手术后第1、3、5、7天检测肺功能和血气分析,比较两组疼痛评分和不良反应发生情况。结果两组术后各时间点肺功能及氧分压(PaO2)均低于术前。观察组除术后5 d最大通气量(MVV)和术后5、7 d肺活量(VC)及术后各时点二氧化碳分压外,其他指标术后各时间点均高于对照组(P<0.05)。观察组术后24、48 h镇痛视觉模拟评分低于对照组(P<0.05),两组不良反应总发生率比较差异无统计学意义(P>0.05),观察组未发生呼吸抑制,对照组发生1例呼吸抑制。结论经胸腹两切口食管癌切除术后应用PCEA镇痛作用稳定而有效,更利于术后早期呼吸功能的恢复。Objective To observe the effect of patient controlled epidural analgesia （PCEA） on the early recovery of respiratory function in patients following esophageal carcinosectomy by right thoracal and upper abdominal double incisions. Methods A total of 50 patients with middle-lower esophageal cancer during March 2009 and March 2013 following right chest and middle of upper abdomen esophageal carcinosectomy were randomly divided into observation group （ n = 28） and control group （n = 22）. The control group underwent postoperative patient controlled intravenous analgesia （PCIA） , and observation group underwent postoperative PCEA. Pulmonary function and blood gas analysis in the two groups were detected 2 d before operation and 1 d , 3 d , 5 d and 7 d after operation, and pain score and adverse reaction rate of the two groups were compared. Results Levels of pulmonary function and Paf）, at postoperative each time were lower than those before operation. Postoperative indexes at each time in observation group were higher than those of control group, excepted for levels of maximal voluntary ventilarion （MVV） at postoperative 5 d , and vital capacity （VC） at postoperative 5 d and 7 d and PaCOz at postoperative each time, and the differences were statistically significant （P 〈 0. 05）. The visual analogue scales （VAS） of observation group at 24 hand 48 h after operation were significantly lower than those of control group （P 〈 0. 05） , and the difference in incidence rate of adverse reactions between the two groups had no statistical significance （P 〉 0. 05）. There was no respiratory depression in observation group, but one patient had respiratory depression in control group. Conclusion PCEA in postoperative application of esophageal carcinosectomy by right thoracal and upper abdominal double incisions may produce stable and effective analgesic effect, and is more beneficial to postoperative rec^very of early respiratory function.

关 键 词：食管肿瘤 食管切除术 镇痛 硬膜外 

分 类 号：R614.42[医药卫生—麻醉学] R735.1[医药卫生—外科学]