肺叶切除术后不同镇痛方法疗效的对比研究  

Comparative study of two different patient-controlled analgesia methods after pulmonary lobectomy

作　　者：皮名芳[1,2] 陈春[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院麻醉科,湖北宜昌443003

出　　处：《热带医学杂志》2015年第6期812-814,共3页Journal of Tropical Medicine

摘　　要：目的对比研究肺叶切除术后静脉自控镇痛与硬膜外自控镇痛效果及对患者早期肺功能的影响。方法选取80例开胸肺叶切除患者随机分为静脉自控镇痛组(PCIA组)和硬膜外自控镇痛组(PCEA组),每组40例。PCIA组术毕应用舒芬太尼静脉自控镇痛,PCEA组应用罗哌卡因和舒芬太尼硬膜外自控镇痛。观察并比较两组患者术后6、12、24、48 h的视觉模拟镇痛评分(VAS)、用力肺活量(FVC)、第一秒用力肺活量(FEV1)、最大分钟通气量(MVV)及不良事件情况。结果 PCEA组术后6、12、24、48 h的VAS评分明显低于PCIA组(P<0.05);两组患者术后48 h内的FVC、FVE和MVV值均较术前明显降低(P<0.05),且PCEA组术后各时段FVC、FVE1和MVV值均高于PCIA组(P<0.05),PCEA组术后恶心呕吐及瘙痒发生率明显低于PCIA组(P<0.05)。结论肺叶切除术后硬膜外自控镇痛效果不仅优于静脉自控镇痛,还有助于改善患者早期的肺功能。Objective To evaluate analgesia effects and lung function of early stage induced by two analgesia methods.Methods 80 patients scheduled for elective lobectomy were randomly divided into patient-controlled intravenous analgesia group with sufentanil（PCIA group,n =40） and patient-controlled epidural analgesia group with ropivacaine and sufentanil（PCEA group,n=40）. Visual analog pain scores（VAS）, forced vital capacity（FVC）, forced expiratory volume in one second（FEV1）, maximum minute ventilation（MVV） and adverse events at postoperative 6 h, 12 h, 24 h, 48 h were observed and compared. Results The VAS of PCEA group at postoperative 6 h, 12 h, 24 h, 48 h was significantly lower than that of PCIA group（P〈0.05）, and postoperative periods FVC, FEV1 and MVV values were higher than those in PCIA group（P〈0.05）. Incidence of adverse events,i.e nausea / vomiting and pruritis were significantly higher in PCIA group than that of group PCEA. Conclusion The analgesia effect of PCEA is not only superior to PCIA, but also can help recovery early pulmonary function in patients undewent lobectomy.

关 键 词：肺叶切除 静脉自控镇痛 硬膜外自控镇痛 肺功能 

分 类 号：R655.3[医药卫生—外科学]