多模式镇痛应用于胸科手术的临床观察

目的:观察多模式镇痛应用于开胸手术围术期的镇痛效果及不良反应,寻求一种安全有效的开胸术后镇痛方法.方法:将40例行择期开胸手术患者随机分为两组,每组20例.A组关胸前由术者行罗哌卡因肋间神经阻滞,手术结束前30min静注帕瑞昔布钠,术毕给予舒芬太尼自控镇痛；B组手术结束时给予舒芬太尼自控镇痛.在经静脉患者自控镇痛( PCIA)开始后2、4、6、8、12、24、48、72h观察记录镇痛(VAS评分)和镇静(Ramsay评分)效果,并观察不良反应发生情况.结果:与B组比较,A组静止及活动状态时的VAS评分、舒适状态评分、舒芬太尼用量、PCA有效按压次数明显下降,B组PCA按压次数比A组上升(P＜0.05)；两组病人术后生命体征,镇静评分,排气时间,恶心、呕吐、皮肤瘙痒、胸闷等副作用的发生率差异无统计学意义(P＞0.05).结论:多模式镇痛对胸科手术患者是一种理想的围术期镇痛方法.

Application of Multimodal Analgesia in Thoracic Surgery

Objective:To observe effect of multimodal analgesia on patients who would undergo open thoracic surgery.Methods:40 patients,who would be conducted routine thoracotomy,were randomly divided into two groups of 20 cases each.Group A received ROM nerve block before thoracic closure and parecoxib(intravenous drip),and received patient-controlled analgesia with sufentanil at the end of the surgery;Group B is given patient-controlled analgesia with sufentanil only at the end of the surgery.The analgesic VAS score,calm Ramsay score and adverse reaction were recorded before 2,4,6,8,12,24,48 and 72 h beginning of PCIA.Results:As compared with group B,the VAS score,comfortable state scores,sufentanil dosage and PCA effective pressing number was decreased obviously at rest and action;PCA pressing number in group B is more than that in group A(P<0.05).After operation,there was no difference in the vital signs,calm score,exhaust time,nausea,vomiting,itchy skin,bosom frowsy between the both groups(P>0.05).Conclusions:Multimodal analgesia therapy is ideal perioperative analgesia in patients under thoracic surgery.