羟考酮联合肋间神经阻滞用于胸腔镜下肺叶切除术后镇痛  

Combination of oxycodone and intercostal nerve block for postoperative analgesia in thoracoscopic lobectomy

作　　者：陈顺富[1] 陈雷[1] 叶钢[1] 

机构地区：[1]浙江省绍兴市人民医院麻醉科,浙江绍兴312000

出　　处：《中国现代医学杂志》2017年第5期100-103,共4页China Journal of Modern Medicine

摘　　要：目的探讨羟考酮联合肋间神经阻滞用于胸腔镜手术后镇痛效果。方法选取160例择期行微创电视辅助胸腔镜(VATS)下小切口肺叶切除术手术的患者采用数字表法随机均分为羟考酮组(Ⅰ组)和羟考酮联合肋间神经阻滞组(Ⅱ组),每组80例,均采用静吸复合全身麻醉。术后均采用盐酸羟考酮注射液经静脉患者自控镇痛(PCIA),Ⅱ组在该基础上联合肋间神经阻滞,记录并比较术后48 h内视觉模拟疼痛评分(VAS)、镇静程度评分(Ramsay)及不良反应的发生情况。结果两组患者在术后相同时间点Ramsay评分比较差异无统计学意义(P>0.05);Ⅰ组患者4、8及12 h时间点的VAS评分高于Ⅱ组,术后12 h内Ⅰ组PCIA按压次数高于Ⅱ组患者(P<0.01),12 h后两组PCA按压次数差异无统计学意义。两组患者在术后各时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2)差异无统计学意义(P>0.05)都在正常范围。两组患者术后恶心、呕吐及嗜睡等不良反应的发生率差异无统计学意义(P>0.05)。结论盐酸羟考酮注射液PCIA联合肋间神经阻滞用于胸腔镜下肺叶切除手术后镇痛,效果优于单纯盐酸羟考酮注射液PCIA。Objective To study the effect of the combination of oxycodone and intercostal nerve block for the postoperative analgesia in thoracoscopic lobectomy. Methods A total of 160 patients underwent minimally invasive video-assisted thoracoscopic （video assisted thoracoscopic surger VATS） small incision lobectomy surgery were equally divided into two groups randomly with the digital table method. Then, patients underwent combination of intercostal nerve block with oxycodone hydrochloride injection and the combination of intercostal nerve block with PCIA. Then the VAS, Ramsay and the adverse reaction occurrence in postoperative 48 h of the two groups were recorded and compared. Results The differences in the ramsay scores of the two groups at the same time point were not statistically significant （ P〉0.05）. The VAS scores of group Ⅰ were higher than that of group Ⅱ at the time points of 4 h, 8 h and 12 h, while their PCA morphine was higher than that of group II within 12 hs after operation （P〈0.01）. No differences in PCA morphine of the two groups occurred after 12 hours. The differences in MAP, HR and SpO2 of the two groups were not statistically important at all postoperative time points （ P〉0.05）. The occurrence rate differences in two groups in terms of the untoward effects were not statistically significant either, including nausea, emesia and somnolence. Conclusions Both Oxycodone hydrochloride injection PCLA and oxycodone hydrochloride PCLA can be combined with intercostal nerve block for the postoperative analgesia of thoracoscopic lobectomy while the latter can better boost the patient＆#39;s recovery than the former.

关 键 词：术后镇痛 羟考酮 肋间神经阻滞 

分 类 号：R614.27[医药卫生—麻醉学]