胸科手术后不同镇痛方法的效果比较

目的:研究观察不同镇痛方法用于胸科手术后的镇痛效果。方法:120例ASAI-II级的开胸手术病人,随机分为肌注哌替啶组、患者静脉自控镇痛(PCIA)组和患者硬膜外自控镇痛(PCEA)组,每组40例。PCIA药物以芬太尼为主,PCEA药物以低浓度布比卡因和吗啡为主,采用视觉模拟评分法观察3组术后镇痛效果,监测术前、术毕、术后6、24、48h的HR、RR、MAP、SpO2及其他临床指标。结果:PCIA组和PCEA组的镇痛效果明显优于肌注哌替啶组(P<0.01);术后6、24h的HR、RR值PCIA和PCEA组也明显低于肌注组;而SpO2则高于肌注组(P<0.01或P<0.05),3组之间MAP相比较无显著性差异;皮肤瘙痒及拔尿管后排尿困难主要发生在PCEA组。结论:PCIA和PCEA用于胸科手术后镇痛都能达到满意的效果。

The comparison of effects on postoperative thoracic surgery with different methods of analgesia

Objective To observe the effect on postoperative thoracic surgery with different methods of analgesia. Method 120 ASAI-II patients who underwent thoracic surgery were randomly allocated to three groups (pethidine group, PCIA group and PCEA group). Every group is consisted of 40 patients. The main medication of PCIA group is primarily Fentanyl and PCEA group is primarily low density Bupivacaine and morphine. Preoperative and postoperative Clinical indices such as HR, RR, MAP, and SpO2 were measured with the visual analogue scale. Results ①Group PCIA and PCEA were significantly better than the group pethidine in postoperative analgesia (P<0.01). ②The HR and RR in 6 and 24 hours post-operative of groups PCIA and PCEA were significantly lower than group pethidine, however SpO2 was elevated, there was no significant difference in MAP amongst the three groups. ③Cutaneous pruritus and dysuria occurred more frequently in group PCEA. Conclusion Both PCIA and PCEA have satisfactory effect in post-thoracic surgery analgesia.