开胸术后多模式复合镇痛和静脉自控镇痛的疗效及安全性比较

目的比较开胸术后多模式复合镇痛和静脉自控镇痛(PCIA)的疗效及不良反应。方法将90例择期行开胸手术患者随机分为氟比洛芬酯+肋间神经阻滞+芬太尼-地佐辛静脉自控镇痛的多模式镇痛组(MA组)、罗哌卡因肋间神经阻滞合并芬太尼-地佐辛静脉自控镇痛组(RP组)及芬太尼-地佐辛静脉自控镇痛组(P组),记录并比较术后48 h内视觉模拟疼痛(VAS)评分、Ramsay评分、不良反应及镇痛泵药量消耗情况。结果 MA组与RP组各时点VAS评分均明显低于P组(P<0.05),术后1、6 h MA组的VAS评分又明显低于RP组(P<0.05);术后1、6、24 hMA和RP组的Ramsay评分均明显低于P组(P<0.05);术后三组恶心呕吐、皮肤瘙痒、呼吸抑制的发生数未见显著性差异(P>0.05);嗜睡在MA组和RP组均显著少于P组(P<0.05);PCA药量消耗MA与RP组均显著低于P组(P<0.05),而MA组的消耗量又明显低于RP组(P<0.05)。结论 MA组、RP组与P组相比镇痛效果优良,不良反应发生率低,开胸术后应用多模式镇痛有利于缓解疼痛,减少不良反应的发生。

Comparison of multimodal analgesia and patient controlled intravenous analgesia for pain relief and safety after thoracotomy

Objective To compare the efficiency and adverse reactions of multimodal analgesia and patient controlled intravenous analgesia（PCIA）.Methods 90 patients experienced thoracotomy were randomly divided into 3 groups： group MA received Flurbiprofen Axetil combined with intercostal nerve block with Ropivacaine,additionally patient controlled Fentanyl-Dezocine intravenous analgesia;group RP received intercostal nerve block with Ropivacaine combined with patient controlled Fentanyl-Dezocine intravenous analgesia;group P received patient controlled Fentanyl-Dezocine intravenous analgesia.The VAS analgesic score,Ramsay sedative score were recorded within 48 hours after operations.The side effects and dose consumption of analgesic pump were evaluated as well.Results The VAS scores of group MA and group RP were much lower than those of group P at 1 h,6 h,24 h and 48 h after operation（P 0.05）;the VAS scores of group MA were much lower than those of group RP at 1 h,6 h after operation（P 0.05）;the Ramsay scores of group MA and group RP were much lower than those of group P at 1 h,6 h,24 h after operation（P 0.05）;there were no significant differences in incidence of postoperative nausea and vomiting,itch of skin and respiratory depression among 3 groups（P 0.05）.The incidence of lethargy of group MA and group RP were lower than that of group P（P 0.05）;the drug consumption in PCA of group MA and group RP were much lower than those of group P（P 0.05）,and amount of consumption of group MA was much lower than those of group RP（P 0.05）.Conclusion Better effect on pain relief and lower incidence of adverse reactions are found in group MA and group RP compared with group P.Application of multi-modal analgesia is in favour of relieving pain,reducing the incidence of adverse reactions after thoracotomy.