局部麻醉镇痛系统与自控静脉镇痛用于胸科手术术后镇痛的比较

目的：比较局部麻醉镇痛系统与自控静脉镇痛（PCIA）用于胸科手术术后镇痛效果。方法：选取40例择期行开胸手术并术后镇痛患者,ASAⅠ-Ⅱ级,随机分为两组：A组采用PCIA,B组使用局部麻醉镇痛系统持续滴注罗哌卡因。用VAS评价苏醒后、术后4、8、12、24、48 h患者静息和运动时的疼痛程度;观察术后恶心呕吐、头痛头晕、嗜睡、尿潴留、皮肤瘙痒、呼吸抑制等不良反应发生率,观察切口有无炎性反应,渗液及愈合情况。结果：两组患者术后镇痛良好,静息时VAS评分〈3,运动时VAS评分〈4;术后8 h内静息时和术后运动时VAS评分,B组明显低于A组（P〈0.05）;术后不良反应发生率B组明显低于A组,差异有统计学意义（P〈0.05）。结论：局部麻醉镇痛系统持续滴注0.375%罗哌卡因的用于胸科手术术后镇痛效果良好,副作用少,患者满意程度更高,是安全有效的术后镇痛方法。

Comparison between local anesthesia analgesic system and patient- control intravenous analgesia for postoperative analgesia in thoracic surgery

Objective： To compare the postoperative analgesic effect after thoracic surgery between local anesthesia analgesic system and patient-control intravenous analgesia （PCIA）. Methods： Forty patients underwent thoracic surgery,ASA Ⅰ-Ⅱ,were randomly divided into two groups-Group A and Group B（20 patients in each）. PCIA was used in Group A, and local anesthesia analgesia system with continuing infusion of 0. 375% ropivacaine was used in Group B. The pain levels were evaluated by VAS during rest and motion state after 4, 8, 12,24 and 48 h of operation. The incidence of adverse reactions including postoperative nausea and vomiting, headache, dizziness, drowsiness, urinary retention, itchy skin, and respiratory depression were observed. The inflammatory reaction, drainage and healing of incisions were observed. Results：The postoperative analgesic effect was good in both groups after operation with resting VAS score~3 and motion VAS score~4. However, VAS score of Group B was significantly lower than that of Group A during both resting and motion state after 8 h of operation （P〈0. 05）. The adverse reactions in Group B were also lower than that of Group A（P〈0.05）. Conclusion：Compared to PCIA, the local anesthesia analgesic system with continuing infusion of 0. 375% ropivacaine can get better analgesic effect, reduce side effects significantly,and obtaine obviously higher satisfaction from patients. The results indicate that local anesthesia analgesic system is a safe and effective method in postoperative analgesia.