开胸术后两种不同镇痛方法的效果比较

目的比较病人开胸手术后应用罗哌卡因，芬太尼硬膜外自控镇痛（PCEA）与芬太尼静脉自控镇痛（PCIA）的临床效果。方法60例ASAⅠ～Ⅱ级，择期开胸手术的病人，随机分为两组，每组30例，PCEA级选用0．15％罗哌卡因加0．0002％芬太尼硬膜外镇痛，PCIA组选用0．001％芬太尼加0．005％氟哌利多静脉镇痛，观察镇痛效果，镇静程度、舒适评分、不良反应，监测RR、SPO2、MAP、HR。结果两组病人视觉模拟评分（VAS）均较低，PCIA组高于PCEA组，但无明显差异（P〉0．05），PCIA组Ramsay法（RSS）镇静评分显著高于PCEA组（P〈0．05），布氏评分法（DCS）舒适评分显著低于PCEA组（P〈0．05）。恶心、呕吐、皮肤瘙瘁等的发生率显著高于PCEA组（P〈0．05），两组病人对术后镇痛总体满意度评估优秀者PCEA组明显多于PCIA组（P〈0．05）。结论对于开胸手术的病人硬膜外罗哌卡因与静脉芬太尼自控镇痛均安全可行，镇痛效果满意，综合总体镇痛质量，PCEA组优于PCIA组，但PCEA镇痛需加强硬膜外导管的管理。

Comparison of Two Odynolysis Methods after Tnoracotomy

Objective To compare the curative effect of odynolysis after tnoracotomy by PCEA and PCIA.Methods The 60 cases of ASA Ⅰ+Ⅱ periods patients who sufered tnoracotomy randomly assigned two groups,one group are 30 cases,the group of PCEA selected epidural odynolysis with ropivacaine(0.15%) and fentanyl(0.0002%),the group of PCIA selected intravenous anesthesia with fentanyl(0.001%)and droperidol(0.005%),The effect of odynolysis,easement score and adverse effect were observed,RR,SPO2,MAP and Hr be detected.Results The score of visual simulation was low in two groups,the group of PCIA was more higher than the group of PCEA,but it had no statistical significance(P>0.05),the group of PCIA was obvious more higher than the group of PCEA in the mitigate score of Ramsay(P<0.05),but it was obvious more lower than the group of PCEA in DSC and easement score(P<0.05).The incidence of gag and disgorging and itch of skin in the group of PCIA more higher than the group of PCEA,the quantity of satisfaction with odynolysis in the group of PCEA obvious more much than in the group of PCIA.Conclusion PCEA was safety and suitable,the effect of odynolysis satisfactory,in a word,the group of PCEA outstrip the group of PCIA in analgesia quality,but PCEA need more command of epidural catheter.