3种镇痛方式在快速康复理念下单孔胸腔镜肺叶切除术后的效果分析  

Effect analysis of 3 analgesic methods after single-hole thoracoscopic lobectomy under the concept of enhanced recovery after surgery

作　　者：张兆晖 刘晓琴 张丽平 廖佳 陈梅 谢天鹏 ZHANG Zhaohui;LIU Xiaoqin;ZHANG Liping;LIAO Jia;CHEN Mei;XIE Tianpeng(Department of Anesthesiology,Cancer Hospital Affiliated to University of Electronic Science and Technology/Sichuan Cancer Prevention and Treatment Center/Sichuan Cancer Hospital&Research Institute,Chengdu,Sichuan 610041,China;Department of Chest Surgery,Cancer Hospital Affiliated to University of Electronic Science and Technology/Sichuan Cancer Prevention and Treatment Center/Sichuan Cancer Hospital & Research Institute,Chengdu,Sichuan 610041,China)

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

出　　处：《重庆医学》2020年第7期1106-1109,共4页Chongqing medicine

摘　　要：目的比较切口局部镇痛、静脉自控镇痛(PCIA)和口服止痛药3种镇痛方式在单孔胸腔镜肺叶切除术后的镇痛效果和不良反应情况。方法纳入该院2018年2-8月拟行单孔胸腔镜肺叶切除患者,分成切口镇痛组、PCIA组和口服止痛组,每组30例。观察并记录患者术后24、48、72 h疼痛评分,以及术后恢复及不良反应情况。结果3组患者术后静态疼痛评分差别较小,差异无统计学意义(P>0.05)。切口镇痛组在术后24、48 h时动态疼痛评分明显低于PCIA组和口服止痛组(P<0.05)。相较于PCIA组,切口镇痛组无腹胀、恶心呕吐、头晕头疼等不良反应,并缩短了术后肛门排气时间(P<0.05);与口服止痛组相比,切口局部镇痛效果更好,减少了术后便秘的发生率。结论切口局部镇痛模式在单孔胸腔镜肺叶切除术后的疼痛管理中取得了较好的镇痛效果,是快速康复理念下单孔胸腔镜手术后较理想的镇痛模式。Objective To compare the effects and adverse reactions of local analgesia,patient-controlled intravenous analgesia(PCIA)and oral analgesia after single-hole thoracoscopic lobectomy.Methods From February 2018 to August 2018,patients undergoing single-hole thoracoscopic lobectomy were divided into three groups:the local analgesia group,the PCIA group and the oral analgesia group,with 30 cases in each group.The pain score,postoperative recovery and adverse reactions were recorded at 24 h,48 h and 72 h after the operation.Results There was no significant difference in static pain score among the three groups(P>0.05).The dynamic pain score in the local analgesia group was significantly lower than that in the PCIA group and the oral analgesia group at 24 hours and 48 hours after operation(P<0.05).The adverse reactions of the PCIA group,such as abdominal distension,nausea and vomit,dizziness and headache and so on,were reduced,so was anal exhaust time(P<0.05).Compared with the oral analgesia group,the effect of local analgesia was better,and the incidence of postoperative constipation was reduced(P<0.05).Conclusion Local analgesia has achieved good analgesia effects in the pain management after single-hole thoracoscopic lobectomy,which is a rather idealized analgesia method under the concept of enhanced recovery after surgery.

关 键 词：切口局部镇痛 静脉自控镇痛 肺肿瘤 单孔胸腔镜 肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤]