后外侧切口开胸术后局部持续局部麻醉药灌注镇痛效果分析  

The clinical effect of posterolateral thoracotomy and local anesthetic infusion on analgesia

作　　者：吴鑫泉 林建清[1] 史海鸿[1] 黎冉[2] 

机构地区：[1]福建医科大学附属第二医院肿瘤科,福建省泉州市362000 [2]福建医科大学附属第二医院麻醉科,福建省泉州市362000

出　　处：《中国综合临床》2014年第6期649-652,共4页Clinical Medicine of China

摘　　要：目的：比较后外侧切口开胸术后局部持续局部麻醉药灌注镇痛与全身持续镇痛的效果。方法行开胸手术患者共107例，均为行食管癌根治术患者。52例术后切口使用麻醉泵加入局部麻醉药持续镇痛（A 组）、55例术后静脉通路镇痛泵全身给药（B 组），比较两组患者术后48 h 镇痛效果、其他镇痛药用量、不良反应发生率，同时比较两组患者术后恢复速度（包括肛门排气时间、离床活动时间、平均住院天数）及切口感染率。结果 A 组的术后镇痛效果[48 h 静息痛视觉模拟评分为（0.5±0.2）分、咳嗽痛视觉模拟评分为（2.0±0.3）分]优于 B 组[分别为（1.7±0.1）、（3.6±0.3）分]，两组比较差异均有统计学意义（P 均〈0.01）。术后48 h 累积肌肉注射吗啡使用剂量：A 组为（15.0±5.5）mg，B 组为（40.5±10.5）mg，两组比较差异有统计学意义（t′=-15.856，P 〈0.05）。A 组术后排气时间、离床活动时间、平均住院天数少于 B 组，但差异无统计学意义（P 均〉0.05）。两组患者不良反应发生率[A 组为51.93％（27/52）、B 组为12.24％（6/55）]比较差异有统计学意义（χ2=21.080，P 〈0.01）。切口感染率比较差异无统计学意义（P 〉0.05）。结论麻醉泵加入局部麻醉药持续镇痛优于静脉通路镇痛泵全身给药。Objective To explore the clinical evaluation of continuous local anesthetic infusion after analgesia ane systemic after thoracic surgery incision open on analgesia. Methods One huneree ane seven patients with thoracic operation,who were uneerwent raeical resection of esophageal cancer patients,were eivieee into A ane B group. Fifty-two cases in A group were given anesthesia pump with local anesthetic analgesia at postoperative（ON-Q pump）,while 55 cases in B group were given intravenous analgesia pump systemic at postoperative. The information inclueing 48 h postoperatively analgesic effect,other analgesics usage amount,the incieence of siee effects at the same time,recovery rate were recoreee. The recovery inclueing anal exhaust time, off bee activity time,average hospitalization eay. Results Forty-eight hours rest pain visual analogue score ane cough,pain visual analogue score in A group were（0. 5 ± 0. 2）ane（2. 0 ± 0. 3）,better than that of B group （1. 7 ± 0. 1,3. 6 ± 0. 3 respectively）,ane the eifference between the two groups were statistically significant（P〈 0. 01）. The opioie cumulative amount in A group was（15. 0 ± 5. 5）mg,less than（40. 5 ± 10. 5）mg in B group,ane there was significant eifference between two groups（t′ = - 15. 856,P 〈 0. 05）. Meanwhile,the anal exhaust time,off bee activity time,the average hospitalization perioes in A group were less than that of B group （P 〉 0. 05）. There were significant eifference between the two groups in terms of aeverse reactions rate（ A group：51. 93%（27 / 52）;B group：12. 24%（6 / 55）;χ2 = 21. 080,P 〈 0. 01）. While there was not significant eifference between two groups in term of the incieence of siee effects（P 〉 0. 05）. Conclusion Anesthesia pump with local anesthetic analgesia is better than that of intravenous analgesia pump systemic aeministration.

关 键 词：后外侧切口开胸术 局部麻醉药灌注 静脉镇痛泵 镇痛药 

分 类 号：R614[医药卫生—麻醉学]