罗哌卡因切口持续灌注用于开胸术后镇痛的疗效及安全性分析  

The Analgesia Efficacy and Safety of Ropivacaine Continuous Infusion at Incision Site after Lobectomia Pulmonalis

作　　者：张兆晖[1] 向润[2] 何金涛[2] 谢天鹏[2] 杨晓军[2] 李强[2] 

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院麻醉科,成都610041 [2]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院胸外科,成都610041

出　　处：《肿瘤预防与治疗》2017年第4期285-290,共6页Journal of Cancer Control And Treatment

基　　金：四川省科技厅科技支撑计划项目(编号:2011FZ0112)

摘　　要：目的:比较手术切口持续镇痛和静脉自控镇痛(PCIA)两种不同镇痛方式在肺癌开放肺叶切除术后的镇痛效果和对患者恢复的影响。方法:选取60例肺癌择期行开放肺叶切除术患者,随机分成切口镇痛组和PCIA组,每组30例;观察并记录患者手术后最大深吸气量,动态、静态疼痛评分以及恢复情况。结果:两组患者在最大深吸气量的恢复过程中最大深吸气量差异无统计学意义(P>0.05),切口镇痛组和PCIA组在术后12h、24h、36h动态疼痛评分分别为(5.57±1.74)分vs.(6.47±1.43)分、(5.43±2.03)分vs.(6.53±2.05)分、(4.43±1.70)分vs.(6.43±1.96)分,切口镇痛组动态疼痛评分低于PCIA组(P<0.05)。切口镇痛组术后肛门排气时间早于PCIA组(P<0.05):(25.13±5.619)h vs.(32.97±6.344)h。切口镇痛组术后头晕头痛(P=0.024)等副反应发生率低于PCIA组。结论:两种镇痛方式均取得了良好的术后镇痛效果,切口局部持续镇痛模式安全有效,减少了术后并发症,更有利于患者胃肠道功能的恢复。Objective： To compare the effect of surgical incision site pain relief system and patient controlled intra- venous analgesia （PCIA） on the pain management and recovery of lung cancer patients who accepted the open lobectomia pulmonalis. Methods： Sixty patients undergoing elective open lobectomia pulmonalis were randomly divided into incision site pain relief system group and PCIA group with 30 patients in each group. The inspiratory capacity, pain score evaluated by visual analogue scale in the resting and dynamic state, and the recovery process of patients after operation were recor- ded. Results： There were no statistical differences in the maximum inspiratory capacity between these two groups （P 〉 0. 05 ）. The pain score of incision site pain relief system group at dynamic state was significantly lower than that of PCIA group （ P 〈 0.05 ） at the time point of 12h, 24h and 36h after operation. The time of anal exhaust in incision site pain relief sys-tem group was also earlier than that of PCIA group （ P 〈 0. 05）. The incidence of side effect such as dizziness and headache in incision site pain relief system group was lower than that in PCIA group（P = 0. 024）. Conclusion： Both the incision site pain relief system group and PCIA group provide excellent analgesia efficacy after lobectomia pulmonalis. The incision local continuous analgesia is safe and effective with lower incidence of postoperative complications, which is beneficial for the recovery of patients.

关 键 词：术后镇痛 切口局部镇痛 静脉自控镇痛 肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤] R730.5[医药卫生—临床医学]