术前骶管内吗啡注射对开胸术后的镇痛疗效观察

目的 观察手术前骶管内吗啡注射对剖胸手术患者术后镇痛疗效的影响，找到一种安全、有效、副作用少的镇痛方法。方法 将45个剖胸手术患者随机分为3组，Ⅰ组为单纯病人自控静脉镇痛（PCIA）组,术毕拔管后静脉给予吗啡1～2mg，术后常规采用PCIA；Ⅱ组为骶管组,手术开始前骶管内注入吗啡1～2mg/2ml+2%利多卡因5ml，术后也常规加用PCIA；Ⅲ组为对照组。Ⅰ、Ⅱ组PCIA泵的设置相同，吗啡30mg/100ml,维持量2ml/h,单次负荷剂量0.5ml/h，锁定时间15min。三组患者术后均随访2，4，8，16，24，48小时，分别记录患者的疼痛程度(采用VAS评分法1])、首次应用PCA的时间（Tp）、不良反应以及是否合用其他镇痛药物。并对结果做出统计学检验。结果 Ⅰ组、Ⅱ组的镇痛效果均优于Ⅲ组；术后16小时内Ⅱ组的镇痛效果优于Ⅰ组、Ⅲ组；Ⅰ组患者Tp早于Ⅱ组患者；Ⅲ组的患者术后均使用其他镇痛药物，Ⅱ组合用其他镇痛药物的人数明显少于Ⅰ组；Ⅱ组患者术后恶心、呕吐的发生率小于Ⅰ组。结论 术前骶管内吗啡的注入能提高剖胸患者手术后的镇痛效果，减少术后全身性镇痛药物的应用。

Treatment efficacy of sacral canal analgesia before thoracotomy

Objective To evaluate the treatment efficacy of sacral canal analgesia before thoracotomy.Methods Forty-five patients with thoracotomy were randomly allocated into three groups.The patients in group Ⅰand group Ⅱ received PCIA with 30mg morphine/100ml arfter surger.The patients in group Ⅰ received a loading dose of morphine 1～2mg,the patients in group Ⅱ received an infusion of morphine 1～2mg via sacral canal before the surger.The group Ⅲ was control group.The PCA pump tate was 2ml/h,blous 0.5ml,lock time 15 min.Analgesia grade were accessed and side effects were recorded.Results There were sifnificant differences in analfesia grade between three groups.The side effects were lower in group Ⅱthan those in group Ⅰ.Conclusion The infusion of morphine via sacral canal can extracted the efficacy of analgesia after thoracotomy,and can reduce side effects.