硬膜外阻滞联合全麻对胸腔镜肺癌根治患者术后智能化静脉病人自控镇痛效应的影响  

Clinical influence of thoracic epidural blockade combined with general anesthesia on postoperative intelligentized patient-controlled intravenous analgesia after video-assisted thoracoscopic surgery for lung cancer

作　　者：胡渤 扶超 李照菊 徐波 HU Bo;FU Chao;LI Zhao-ju;XU Bo(Department of Anesthesiology,General Hospital of Southern Theatre Command of the PLA/Clinical Center of Anesthesiology of the PLA,Guangzhou 510010,Guangdong,China)

机构地区：[1]中国人民解放军南部战区总医院麻醉科、全军临床麻醉中心,广东广州510010

出　　处：《广东医学》2020年第11期1106-1111,共6页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(61773130);军队科技计划项目(CWH17J024);广州市科技计划项目(201804010060)。

摘　　要：目的通过应用智能化病人自控镇痛(Ai-PCA)管理系统,对胸段硬膜外阻滞联合全麻用于胸腔镜肺癌根治术后低背景剂量的静脉病人自控镇痛(PCIA)的影响进行分析.方法选取胸腔镜肺癌根治术后使用舒芬太尼联合右美托咪定静脉镇痛患者126例,分为静脉全身麻醉+PCIA组(II组)和硬膜外复合全身麻醉+PCIA组(EI组),每组63例;两组均于手术结束前30 min实施PCIA,PCIA配方为舒芬太尼3μg/kg+右美托咪定2.5μg/kg,加生理盐水稀释至150 mL,参数设置为:负荷量为5 mL,持续背景剂量为1 mL/h,Bolus剂量为2 mL,锁定时间15 min,极限量12 mL/h;观察PCIA即刻(T0)、术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)的静息VAS评分、运动VAS评分和镇静评分(Ramsay评分),记录PCIA T0~T1、T1~T2、T2~T3和T3~T4和T4~T5等时间段内的按压次数和有效按压次数;记录术中瑞芬太尼、0.125%罗哌卡因、丙泊酚等麻醉药用量和患者补救药品的使用例数;观察不良反应和患者综合满意度等.结果两组的手术时间、失血量、PACU时间、术中麻醉药用量差异无统计学意义(P>0.05).II组在术后6 h的R-VAS和M-VAS以及术后12 h和24 h的M-VAS均高于EI组(P<0.05).两组在术后各时间点的Ramsay评分组间比较差异无统计学意义(P>0.05).II组在T1~2、T2~3和T3~4内按压次数及有效按压次数均高于EI组(P<0.05),II组的术后SF和Dex用量均明显高于EI组(P<0.05).II组氟比洛芬酯的使用率高于EI组(P<0.05).结论经硬膜外阻滞联合全麻用于胸腔镜肺癌根治术后智能化PCA管理系统分析,罗哌卡因硬膜外阻滞可以有效降低胸腔镜肺癌根治术后PCIA的药量,提高患者早期镇痛效果,方便术后管理,有利于患者术后康复.Objective Base on intelligentized patient-controlled intravenous analgesia(PCIA)system,the clinical influence of thoracic epidural blockade after video-assisted thoracoscopic surgery were analyzed.Methods A total of 126 patients undergoing video-assisted thoracoscopic surgery were recruited and randomly assigned to 2 groups,GroupⅡ(intravenous anesthesia and PCIA,n=63)and Group EI(thoracic epidural blockade combined with intravenous anesthesia and PCIA,n=63).Each group received PCIA 30 min before the end of the surgery.The PCIA protocol was sufentanil 3μg/kg combined with dexmedetomidine 2.5μg/kg in both group,diluted by saline to 150 mL.The background flow rate was 1 mL/h and the Bolus dose was 2 m L,and the lock-time was 15 min,the maximal infusion volume was modified to 12 m L/h.Pain at rest and during movement were assessed by the visual analogue scale pain score(R-VAS and M-VAS)2 h(T 1),6 h(T 2),12 h(T 3),24 h(T 4),48 h(T 5)after surgery.The level of sedation simultaneously was assessed using the Ramsay Sedation Scale.The times and effective times of bolus press were recorded within each intervals.The dose of anesthesia agents(rem ifentanil,ropivacaine and propofol)during operation and other m edications were recorded.The rate of satisfaction and side effects were evaluated and recorded.Results There were no signifi-cant differences in the surgery tim e,blood loss or PACU time.Scores of R-VAS and M-VAS 6h after surgery and M-VAS 12 h and 24 h after surgery of Group Ⅱ were higher.There was no significant difference of the scores of Ramsay at each time points after surgery between the 2 groups.The times and effective times of bolus press were more in Group Ⅱ from 2 h to 24 h after PCI A.The consumption dose of sufentanil and dexmedetomidine were higher in Group Ⅱ.The use of flurbiprofen were more in Group Ⅱ.There was no significant difference in side effects or satisfaction between the 2 groups.Conclusion Base on intelligentized PCIA,the thoracic epidural blockade reduced demands of opioid after vid

关 键 词：人工智能 硬膜外阻滞 胸腔镜 病人自控静脉镇痛 

分 类 号：R441.1[医药卫生—诊断学] R614[医药卫生—临床医学]