多模式镇痛在胸科手术术后镇痛应用的临床观察

目的对多模式镇痛对于胸科手术术后镇痛效果和不良反应进行观察，以期找到更为安全有效的胸科手术术后镇痛方式。方法将60例择期接受胸科手术的患者随机分为实验组和对照组，每组30例，实验组患者在关胸前由手术者使用罗哌卡因进行肋间神经的阻滞，在手术结束之前30min静脉注射帕瑞昔布钠，并于手术结束时给予舒芬太尼以自控镇痛；对照组在手术结束时给予舒芬太尼以自控镇痛。于患者经静脉给药自控镇痛（PCIA）开始后第2、4、6、8、12、24、48、72h对镇静（Ramsay评分）和镇痛（VAS评分）效果观察记录，同时对不良反应发生情况进行观察。结果相较于对照组，实验组患者PCA有效按压次数、舒芬太尼用量、舒适状态评分、静止和活动状态下VAS评分明显下降，对照组PCA按压次数较实验组上升（P〈0．05）；两组患者在术后胸闷、皮肤瘙痒、恶心呕吐、排气时间、镇静评分、生命体征等副作用发生率均没有显著差异（P〉0．05）。结论多模式镇痛对于胸科手术术后镇痛效果良好，有临床推广价值。

A clinical observation of multimodal analgesia in the application of analgesia after thoracic surgery

Objective To observe the analgesic effect of multimodal analgesia after thoracic surgery and related adverse events, so as to find a safe and effective analgesic method after thoracic surgery. Methods 60 patients receiving selective thoracic surgery were randomly allocated to an experimental group and a control group, with 30 patients in each group. The surgeon used ropivacaine to block the intercostal nerve before sternal closure for patients in the experimental group. Patients were intravenously administered parecoxib sodium in 30 rain before the end of the surgery, and were then given sufentanil for patient-controlled analgesia at the end of the surgery; patients in the control group were given sufentanil for patient-controlled analgesia at the end of the surgery. From the beginning of intravenously administered patient-controlled analgesia （PCIA）, the effects of sedation （Ramsay scores） and analgesia （VAS scores） in 2, 4, 6, 8, 12, 24, 48, 72 h were observed and recorded, and the adverse events were observed simultaneously. Results Compared with the control group, effective pressing times of PCA, dosage of sufentanil, Bruggrmann comfort scale, VAS scores under calmness and activity in the experimental group significantly reduced, and the pressing times of PCA in the control group increased compared to those in experimental group （P 〈 0.05）; incidences of chest disorder, pruritus, nausea and vomit, time of passage of gas, Ramsay scores and vital signs in the two groups after the surgery were not significantly different （P 〉 0.05）. Conclusion Muhimodal analgesia has a favourable analgesic effect for thoracic surgery, which is worthy of clinical promotion.