三种不同自控镇痛方案对胸腔镜下肺癌手术治疗病人镇静镇痛的影响  

Effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer

作　　者：于乐涛 夏国庆 尹玉良 YU Letao;XIA Guoqing;YIN Yuliang(Department of Anesthesiology,the First Hospital of Anhui University of Science&Technology,Huainan,Anhui 232007,Anhui,China)

机构地区：[1]安徽理工大学第一附属医院麻醉科,安徽省淮南市232007

出　　处：《临床外科杂志》2024年第8期882-886,共5页Journal of Clinical Surgery

基　　金：2022年度淮南市市级科技计划项目(2022170)。

摘　　要：目的探讨三种不同自控镇痛方案对肺癌手术病人镇静镇痛的影响。方法2022年11月~2023年4月行胸腔镜下肺癌手术治疗病人93例。根据术后镇痛方式不同分为静脉自控镇痛组(P组,30例)、静脉自控镇痛联合椎旁神经阻滞组(T组,31例)和静脉自控镇痛联合前锯肌平面阻滞组(S组,32例)。比较三组术后视觉模拟疼痛评分(VAS)、Ramsay评分、镇痛泵按压次数、镇静药物使用情况、不良反应,比较T组和S组麻醉平面、阻滞操作时间、阻滞起效时间、阻滞持续时间。结果静息状态下P组术后2小时、24小时、48小时VAS评分分别为(3.09±0.69)分、(2.83±0.59)分和(2.07±0.51)分,高于T组的(1.22±0.33)分、(2.51±0.54)分、(1.57±0.45)分和S组的(1.01±0.30)分、(2.23±0.51)分、(1.22±0.25)分,T组高于S组;咳嗽状态下P组术后2小时、24小时、48小时VAS评分分别为(3.63±0.55)分、(3.24±0.67)分和(2.61±0.51)分,高于T组的(1.45±0.29)分、(2.71±0.56)分、(2.33±0.53)分和S组的(1.14±0.28)分、(2.40±0.57)分和(2.03±0.52)分,T组高于S组;三组比较差异有统计学意义(P<0.05)。P组术后2小时、24小时、48小时Ramsay评分分别为(2.21±0.51)分、(2.34±0.56)分和(2.31±0.55)分,T组分别为(2.23±0.53)分和、(2.35±0.55)分和(2.33±0.54)分,S组分别为(2.22±0.52)分、(2.36±0.57)分和(2.32±0.55)分,三组比较差异无统计学意义(P>0.05)。P组术后24小时、48小时镇痛泵按压次数分别为(10.18±2.42)次、(14.51±3.20)次,高于T组的(3.32±0.79)次、(6.84±1.62)次和S组的(1.17±0.28)次、(2.63±0.62)次,T组高于S组,三组比较差异有统计学意义(P<0.05)。P组术后舒芬太尼追加剂量为(8.05±1.99)μg,舒芬太尼使用总量为(71.53±6.91)μg,多于T组的(3.77±0.93)μg、(65.82±5.77)μg和S组的(2.23±0.55)μg、(47.54±4.56)μg,T组多于S组,三组比较差异有统计学意义(P<0.05)。S组阻滞操作时间为(5.32±1.77)分钟,短于T组的(12.41±3.42)分钟,阻滞持续时Objective To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P(n=30)was given patient-controlled intravenous analgesia,group T(n=31)received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S(n=32)received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale(VAS)score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results VAS scores in the resting state at postoperative 2 h,24 h and 48 h were(3.09±0.69),(2.83±0.59)and(2.07±0.51)in group P,which were higher than group T[(1.22±0.33),(2.51±0.54)and(1.57±0.45)]and group S[(1.01±0.30),(2.23±0.51)and(1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2 h,24 h and 48 h were(3.63±0.55),(3.24±0.67)and(2.61±0.51)in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56)and(2.33±0.53)]and group S[(1.14±0.28),(2.40±0.57)and(2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2 h,24 h and 48 h yielded statistical difference among three groups(all P<0.05).Ramsay sedation scores at postoperative 2 h,24 h and 48 h were(2.21±0.51),(2.34±0.56)and(2.31±0.55)in group P,(2.23±0.53),(2.35±0.55)and(2.33±0.54)in group T and(2.22±0.52),(2.36±0.57)and(2.32±0.55)in group S,with no statistical difference(all P>0.05).The press times of analgesic pump at postoperative 24 h and 48 h were

关 键 词：静脉自控镇痛 椎旁神经阻滞 前锯肌平面阻滞 肺癌 胸腔镜 镇痛 镇静 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]